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Child Dev: Psychopathology > Midterm 2 (Final) > Flashcards

Midterm 2 (Final) Flashcards

1
Q

What are the 10 different substances found in the DSM-5 for Substance-Use Disorder?

A

○ Alcohol
○ Caffeine
○ Cannabis
○ Hallucinogens
○ Inhalants
○ Opioids
○ Sedatives
○ Stimulants
○ Tobacco
○ Other substances

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2
Q

Substance use in adolescence is associated with what 3 leading causes of death for adolescents?

A
  • Accidents/injuries
  • Suicide/self-harm
  • Interpersonal violence
  • Also, educational problems and legal problems
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3
Q

What age period is a risk period for substance use problems?

A
  • Adolescence
  • Earlier use = higher risk for problematic use
  • Earlier you start, the more likely you are to have significant impairment
  • Ex: ~15% of kids who start drinking by 14 develop
    AUD -> compared to only ~2% who start at 21+
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4
Q

What’s the prevalence of high school students in the US that reported drinking alcohol in the past year?

A

In the US, 2/3 of students in Grade 12 and nearly 1⁄2 of students in Grade 10 report drinking alcohol in the past year

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5
Q

What’s the lifetime prevalence of any substance use disorder according to the NCS-A (national comorbidity survey – adolescent)?

A
  • Adolescents aged 13 - 18yrs: 11.4%
  • 13-14 yrs: 3.7%
  • 15-16 yrs: 12.2%
  • 17-18 yrs: 22.3%
  • Big jump from 13-14 to 17-18
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6
Q

Describe the Monitoring the future study and their findings

A
  • Study of American youth
  • Asking children questions about substance use
  • Can track patterns of use over the years
  • Found that substance use went down in teens during the pandemic (lockdown) -> they were at home with parents and had less interaction with peers
  • Found that these numbers stayed down -> even with lockdown ending
  • Substance use hasn’t grown much since (still below pre-pandemic levels)
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7
Q

What are the 3 treatment models for SUD?

A
  • Early Brief Interventions
  • Outpatient Treatment
  • Residential Inpatient Treatment
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8
Q

Describe Early Brief Interventions for SUD

A
  • Use of norm-based interventions for college students
  • Online training provided by school (ex: Alcohol EDU)
  • Understanding norms about drinking
  • Injunctive norms: how much others approve or disapprove of drinking
  • Descriptive norms: how much others actually drink
  • Popular culture -> people have a sense that everyone in university is drinking and going out all the time
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9
Q

Describe Lewis & Neighbours (2004) findings for norm-based interventions for SUD

A
  • They asked people the amount of drinks they have per week vs what they think the amount of drinks other people have per week is
  • Perceptions are much higher than reality
  • Big discrepancy between what people are actually doing and what their peers are actually doing
  • People are overestimating how much their peers drinks
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10
Q

Describe Neighbours, Larimer, & Lewis (2004) brief alcohol screening and intervention for college students

A
  • They provided college students’ with individualized feedback about actual drinking norms and a comparison between individual’s drinking pattern and the norm
  • Ex:
    1) This is how much you drink
    2) This is how much you think others drink
    3) This is how much others actually drink
    4) Percentile ranking showing where you are relative to others on your campus
  • This provided college students with an accurate depiction of drinking norms on campus
  • Found that the impact that these interventions have on people’s drinking are mediated by changes in people’s perceived norms -> see the lower number of drinking and change their drinking habits to conform to others
  • Changes in perceived norms may mediate treatment effects
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11
Q

Describe Hennessy et al. (2019) study on the effectiveness of norm-based interventions for college students

A
  • Network meta-analysis of 7 manualized brief alcohol interventions
  • Found that most programs generally worked well in reducing drinking frequency & quantity for 0-6+ months post-interventions
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12
Q

What are the different types of outpatient treatment for SUD?

A
  • Family Therapy
  • Alcoholics Anonymous (12 Step Programs)
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13
Q

Describe the outpatient treatment approach of family therapy for SUD

A
  • Multidimensional Family Therapy -> similar to multi-systemic treatment
  • Much more intensive outpatient treatment
  • Working with parents and adolescent
  • Adolescent (ex: use as a means of coping with distress or negative emotions)
  • Parents (ex: increased parental monitoring)
  • Number of studies have supported the efficacy for multidimensional family therapy
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14
Q

Describe the outpatient treatment approach of Alcoholics Anonymous for SUD

A
  • Very popular -> people experiencing problematic alcohol use seek out AA more than all other forms of treatment combined
  • 12 steps program
  • Acknowledge that alcohol is a problem
  • Recommend abstinence
  • Supported by a peer
  • Easily accessible (worldwide program)
  • Participation in AA is associated with less alcohol consumption & fewer substance related problems
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15
Q

What are the 3 hypotheses for why participation in AA is associated with less alcohol consumption & fewer substance related problems?

A
  1. AA attendance -> going to meetings can lead to lower substance use
  2. Lower alcohol use is associated with AA attendance -> higher alcohol use makes you less likely to attend because AA promotes abstinence which seems impossible for more severe cases. Also can recover quicker with lower severity.
  3. People with good prognosis (less general risk factors and more productive factors) use less alcohol and are more likely to attend AA and benefit from AA
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16
Q

Describe the results for the randomized trials comparing AA to another form of treatment or to a no treatment control group

A
  • Results suggest AA does not do better and may do worse
  • However, there are very few well-done studies -> because it’s anonymous and a helpful resource that can be used whenever they want -> people less likely to want to be part of a study when they go to AA
  • In several of the randomized trials, participants were coerced into treatment (ex: court referred)
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17
Q

Describe the recent study on men seeking treatment for alcohol use at the Veterans Association hospital

A
  • Study examining 2000 men seeking treatment for alcohol use at VA hospital
  • All met criteria for a diagnosis of AUD
  • Received treatment
  • After finishing treatment, researchers followed them and collected data about their substance use and their attendance at AA meetings
    Hypotheses & Findings:
    1) AA attendance → Lower alcohol use
  • AA involvement at 1 year post treatment predicted less alcohol use at 2 years post treatment
    2) Lower alcohol use → AA attendance
  • Alcohol use at year 1 did not predict AA involvement at year 2
    3) Good prognosis (ex: better motivation, less co-morbid psychopathology)→lower alcohol use and AA
  • Results not explained by alcohol use severity, motivation, or co-morbid psychopathology
  • Findings in support of 1st hypothesis but not 2nd and 3rd
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18
Q

Describe the inpatient treatment approach for SUD

A
  • Inpatient = in the hospital
  • Some might self-select into inpatient treatment
  • For children, parents may put them into these facilities
  • Short duration (4 - 6 weeks)
  • Range of treatment programs
  • Individual counselling, family therapy, treatment for comorbid disorders
  • Often followed by outpatient -> after you leave you may come back once or 2x a week
  • High level of monitoring in these facilities
  • Inpatient treatments are relatively common and have a good rationale -> have to change daily environment because there are probably many triggers in that environment
  • Very few controlled studies have examined the efficacy
    of inpatient treatment for substance use
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19
Q

What disorders comprise internalizing symptoms?

A
  • Anxiety disorders
  • Mood disorders
  • Cluster of interrelated problems (anxiety and mood disorders are highly related - comorbidity is very high)
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20
Q

What’s the developmental psychopathology framework for internalizing symptoms?

A
  • We evaluate what’s abnormal in the context of what’s typical for children of a specific age
  • Fear and sadness are important emotions
  • “Normal” fears come and go over development
  • Anxiety and fluctuating mood can be normal
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21
Q

Describe the impairment associated with anxiety disorders

A
  • Associated with significant impairment
  • Social impairment: excluded, unliked, victimized, lower popularity
  • Academic impairment: test anxiety, with SOC afraid to speak up to ask questions in class
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22
Q

Describe the service utilization with anxiety disorders

A
  • Low service utilization
  • Anxiety problems often go untreated
  • Most youth with mental health problems don’t receive treatment
  • According to the NCS–A, Percentage of Adolescents Who Report Using MH Services, adolescents with any anxiety disorder have the lowest usage of mental health services
  • Girls with anxiety are more likely to receive services than boys with anxiety
  • Older adolescents are more likely to receive services for anxiety
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23
Q

What are 3 reasons that potentially explain why youth with any anxiety disorder have the lowest usage of mental health services

A

1) Some Fear and Anxiety is Normal
- Nearly all 1yr-olds become distressed when separated from mom
- Most children have short-lived specific fears
- ~1/2 of children aged 6-12 have 7 or more fears
- As long as it’s not causing disability, distress, or risk
2) Some Anxiety is Adaptive
- Some situations might and should provoke anxiety
- Ex: stranger anxiety in young children, test anxiety, excessive checking of homework and assignments
- Moderate levels of anxiety might lead to the highest level of performance (being too anxious may impede your performance and being too nonchalant may make you not try as hard)
3) May not be as upsetting to adults
- May not be causing as much disruption and may be associated with favourable characteristics (ex: less aggression)

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24
Q

What are the core features of anxiety disorders?

A
  • Focus on threat or danger
  • Future-oriented (“anxious apprehension”) -> differs from fear (present-oriented)
  • Strong negative emotion or tension, displayed as:
  • Physical sensations
  • Cognitive shifts (ex: worries)
  • Behavioural patterns (ex: strong fight or flight response)
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25
Q

What are the 7 different DSM-5 anxiety disorders?

A
  • Separation Anxiety Disorder (SAD)
  • Generalized Anxiety Disorder (GAD)
  • Specific Phobia
  • Social Anxiety Disorder
  • Panic Disorder (PD)
  • Agoraphobia
  • Selective Mutism
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26
Q

How do the DSM-5 anxiety disorders differ from one another?

A
  • Vary on focus/content of threat
  • Vary on balance of symptoms (ex: worry-based vs physical)
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27
Q

Describe Specific Phobia

A
  • Fear of specific situations or things
  • Common type of anxiety disorder (ex: at least 20% of children are affected by specific phobia at some point in their lives)
  • Some grow out of these and some don’t
  • More common in girls than boys
  • Onset: middle childhood (7-9 yrs old)
  • Clinical phobias are more likely to persist overtime (contrary to just fears)
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28
Q

Describe Separation Anxiety

A
  • Separation from or harm coming to loved ones
  • Don’t want to be separated from parents
  • Worrying about events that might separate them from parents
  • Occurs in 4-10% of children
  • More prevalent in girls than in boys
  • Usually see this around school ages
  • Has high levels of comorbidity
  • Ex: 2/3 of children with separation anxiety have some other anxiety disorder
  • 1/3 of children have features from separation anxiety that persist into adulthood (move from parents to new figure in that person’s life)
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29
Q

Describe Social Anxiety

A
  • Fear of negative evaluation by others
  • Fear of social situations in which person will be evaluated (ex: going to a party with friends)
  • For children, must occur in peer settings (not just with adults -> ex: teachers or parents)
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30
Q

Describe Selective Mutism

A
  • Failure to speak in specific situations and contexts in which speaking is expected, even though they may speak in other settings
  • Reclassified as an anxiety disorder in DSM-5, but not clear that all children with selective mutism are anxious
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31
Q

Describe Generalized Anxiety Disorder

A
  • Excessive, uncontrollable anxiety and worry
  • Worrying can be episodic or almost continuous
  • Worry excessively about minor (or important) everyday occurrences
  • Somatic (physical symptoms as well)
  • More global/broad/general type of anxiety disorder -> makes it more difficult to treat
  • Equally common in boys and girls -> tend to see similar levels in both
  • GAD tends to onset in adolescence
  • Older children tend to have more symptoms than younger children with GAD
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32
Q

What’s a panic attack?

A
  • Short period of intense fear or discomfort that develops abruptly and is accompanied by at least 4 symptoms (ex: sweating, shortness of breath, choking feeling, chest pain, nausea)
  • A lot of people when they have their first panic attack, they go to the ER because they feel like they’re having a heart attack
  • You can have panic attacks and not have panic disorder
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33
Q

Describe Panic Disorder

A
  • Characterized by panic attacks
  • Not panic disorder if cued by phobia (ex: being scared of cats and having a panic attack in room filled with cats)
  • Often people might change their behaviours and avoid situations or contexts where their past panic attacks occurred
  • Panic attacks shouldn’t be better explained by another disorder
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34
Q

Describe obsessions in Obsessive-Compulsive Disorder (OCD)

A
  • Recurrent, persistent thoughts, impulses, or images that are experienced as intrusive, inappropriate, and that cause marked anxiety or distress
  • These thoughts aren’t simply excessive worries about real-life problems
  • Individual attempts to ignore or suppress the thoughts or to neutralize them with another thought or action
  • Individual recognizes that the thoughts are a product of their own mind
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35
Q

What are common obsessions in Obsessive-Compulsive Disorder (OCD)?

A
  • Contamination
  • Harm to self or others
  • Symmetry
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36
Q

Describe compulsions in Obsessive-Compulsive Disorder (OCD)

A
  • Repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
  • The behaviors or mental acts are aimed at preventing/reducing distress or preventing some dreaded events or situations
  • These behaviors/mental acts are either not connected in a realistic way with what they are designed to neutralize or prevent, or they are clearly excessive
  • Can be cognitive in nature
  • Often the compulsion isn’t logically connected to the obsession
  • Poor insight (ex: in children) can lead to poorer prognosis of disorder
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37
Q

What are common compulsions in Obsessive-Compulsive Disorder (OCD)?

A
  • Counting
  • Checking
  • Washing
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38
Q

According to the NCS-A, what’s the lifetime prevalence of the different anxiety disorders + OCD during childhood and adolescence (in order)?

A
  • Any anxiety disorder: 32%
  • Specific phobia: 19% (most don’t get treatment)
  • Social Phobia: 9%
  • Separation anxiety: 8%
  • Generalized Anxiety Disorder: 2%
  • Panic Disorder: 2% (panic attacks may be more common than panic disorder)
  • OCD: 1%-2%
  • Selective Mutism: 0.7%
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39
Q

What are the gender differences in anxiety and OCD disorders?

A
  • Girls are more likely than boys to meet diagnostic criteria for an anxiety disorder -> usually ratio of 2:1 for girls
  • As they grow up, the gender disparity is getting wider between men and women
  • OCD has as 2:1 male to female ratio -> more boys are diagnosed with OCD than girls and that gender gap is pretty consistent across development
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40
Q

Describe Socioeconomic & Ethic differences in anxiety disorders

A
  • Anxiety is present across socioeconomic strata and cultures -> specific, contextual experiences may shape what anxiety looks like
    Socioeconomic status:
  • Lower levels of parental education and living in a single-parent headed household associated with greater likelihood of having an anxiety disorder
    Ethnicity:
  • Anxiety disorders more common among Black youth than White youth, but White youth receive services for anxiety more than Black youth -> race-based rejection sensitivity might be a contributor (worries or anxieties about whether someone will discriminate against you)
  • Big overlap between being in a racially marginalized group and being lower SES
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41
Q

Is there comorbidity between the anxiety disorders?

A
  • Yes, youth who have one anxiety disorder often meet criteria for others
  • Comorbidity tends to be the norm
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42
Q

Describe the comorbidity of Selective Mutism with other anxiety disorders

A
  • 80% of youth with selective mutism meet diagnostic criteria for another anxiety disorder
  • 69% of youth with selective mutism meet diagnostic criteria for social phobia (AKA Social Anxiety Disorder)
  • However, there are youth with selective mutism who don’t report experiencing significant anxiety
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43
Q

Describe the comorbidity of Depression and anxiety disorders

A
  • Diagnostic co-morbidity can be as high as 75 to 80%
  • According to the Ontario Child Health Study
  • 6 month prevalence
  • 77% of adolescents who meet criteria for Major Depression also meet criteria for an anxiety disorder
  • 45% of adolescents who meet criteria for an anxiety disorder also meet criteria for major depression
  • High comorbidity between mood and anxiety disorders
  • Often symptoms of anxiety disorder precedes a depression onset
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44
Q

What’s the symptom overlap between GAD and MDD?

A
  • Fatigue
  • Sleep disturbance
  • Irritability
  • Concentration difficulties
  • Both characterized by negative affectivity (extent to which person feels distress)
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45
Q

Describe the relationship between positive affectivity, anxiety, and depression

A
  • Positive affectivity is negatively correlated with depression, but is independent of anxiety symptoms and diagnoses
  • Positive affectivity is an independent dimension of affect
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46
Q

Describe the academic difficulties that youth with anxiety disorders face

A
  • Youth with anxiety disorders typically have IQs in the typical range
  • Symptoms may interfere with academic functioning
  • Impact of worry on concentration
  • School refusal/Difficulty remaining in school (separation anxiety, social anxiety)
  • Selective mutism
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47
Q

Describe the social difficulties that youth with anxiety disorders face

A
  • Shy/withdrawn children become increasingly rejected by peer group with age
  • More likely to experience peer victimization
  • People with anxiety perceive their friendships as being of lower quality
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48
Q

What are the “typical” age of onset for each fear?

A
  • 2 yrs old: loud noises, animals, dark, separation
    from parents
  • 5 yrs old: animals, dark, separation from parents, bodily injuries, “bad” people
  • 7-8 yrs old: dark, supernatural beings, being alone, bodily injuries
  • Worries become more complex as youth age
  • These fears, worries, and rituals are developmentally appropriate
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49
Q

What are the different ages of onset for the different anxiety disorders (youngest to oldest)?

A
  • Separation Anxiety Disorder (7-8)
  • OCD (9-12) -> some children will show it very early (6-10)
  • Generalized Anxiety Disorder (10-14)
  • Social Phobia (adolescence)
  • Panic Disorder (adolescence)
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50
Q

What’s the prognosis of Anxiety Disorders?

A
  • Research is ongoing to determine what the long-term outcomes of anxiety disorders are
  • Homotypic continuity: disorder predicting itself overtime (ex: separation anxiety at 7 → separation anxiety at 17)
  • Heterotypic continuity: a disorder at one point will predict the onset of a different disorder (ex: social anxiety → depression)
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51
Q

Describe the heritability of anxiety

A
  • Evidence that tendencies towards anxiety are inherited (genetic component of anxiety isn’t specific to a certain disorder)
    1. Children of parents with anxiety disorders are ~5X more likely to have an anxiety disorder than are children whose parents do not have anxiety disorders
    2. Twin studies indicate that 33% of variability in anxiety is heritable
  • Identical twins may have different anxiety disorders from each other
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52
Q

Describe the biological predisposition to anxiety

A
  • Inherit a general vulnerability (diathesis) to anxiety disorders
  • Ex: Temperament -> behavioral inhibition (fear and distress in response to novel situations, withdrawal) & negative emotionality
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53
Q

What’s the 2-stage model of fear acquisition?

A
  • Etiological and maintenance model for specific phobia (Mowrer)
  • Stage 1: fear develops through classical conditioning
  • Stage 2: avoidance behavior maintained through operant conditioning
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54
Q

What are the different mood disorders in youth?

A
  • Major Depressive Disorder (MDD)
  • Persistent Depressive Disorder (PDD - AKA Dysthymic Disorder)
  • Disruptive Mood Dysregulation Disorder (DMDD)
  • Bipolar disorder (I & II)
55
Q

What are the core features of depression?

A
  • Dysphoria (prolonged sadness, low consistent mood)
  • Irritability (excessive sensitivity, hostility, and moodiness) -> unique to children and adolescents
  • Irritability tends to be a common manifestation of low mood and depression in children
  • Anhedonia (loss of pleasure or interest in previously enjoyable activities)
56
Q

What’s the difference between Symptom, Syndrome, & Disorder?

A
  • Symptom (feeling or emotion of sadness -> very common)
  • Syndrome (cluster of common symptoms -> extreme on dimension of negative mood/affect)
  • Disorder/Diagnosis (syndrome that has been occurring for a certain amount of time)
57
Q

What are the 8 different specifiers for Depressive Disorders?

A
  1. Anxious distress
  2. Mixed features (some manic/hypomanic symptoms that don’t meet bipolar disorder threshold)
  3. Melancholic features (experience no pleasure)
  4. Atypical features
  5. With psychotic features (mood congruent or mood incongruent)
  6. With catatonia
  7. Peripartum onset
  8. Seasonal pattern
    - All of these can apply to MDD
    - Only Anxious Distress and Atypical Features specifiers can be applied to PDD
58
Q

Describe Persistent Depressive Disorder

A
  • Persistent low mood
  • Depressed or irritable mood for most of the day, more days than not, as indicated by either subjective account or by observation by others
  • In adults, mood must be depressed and must last for 2 years
  • For children and adolescents, must last for only 1 year
  • Presence while depressed, of 2 (or more) of the following:
  • Poor appetite or overeating
  • Insomnia or hypersomnia
  • Low energy or fatigue
  • Low self-esteem
  • Poor concentration or difficulty making decisions
  • Feelings of hopelessness
  • During the 1 year period, the person has never been without the symptoms for more than 2 months at a time
59
Q

Can you have both PDD and MDD at the same time?

A
  • Yes
  • Can have PDD with persistent major depressive episodes -> persistent low mood with severe MDD episodes
  • Can have PDD with intermittent major depressive episodes -> 1 or 2 distinct major depressive episodes
  • Pure PDD -> PDD with no major depressive episodes
60
Q

Describe Disruptive Mood Dysregulation Disorder (DMDD)

A
  • New to DSM-5
  • Key characteristic: irritability
  • Can’t be diagnosed in adults
  • Inconsistent with developmental level -> may expect young children to lose control when upset, but wouldn’t expect it from a teenager
  • Childhood mood disorder
  • Created because there were a lot of kids that were diagnosed with pediatric bipolar disorder who presented primarily with irritability
  • Not diagnosed concurrently with ODD (DMDD is more severe) or Bipolar disorder (bipolar disorder = episodic & DMDD = chronic irritability)
  • Research on this disorder is very limited
61
Q

Describe Axelson et al. (2013) study on DMDD

A
  • Examined DMDD in a large sample of 6- to 12-year-olds seeking psychiatric services
  • Found that DMDD was not well-differentiated from CD or ODD (weren’t good at using the criteria to say who has one vs another disorder -> hazy boundaries)
  • No difference between youth with and without DMDD diagnosis in symptom severity or functional impairment
  • DMDD diagnosis showed poor stability
62
Q

Describe Copeland et al. (2013) study on DMDD

A
  • They examined the DMDD criteria in 3 large community samples
  • 3-month prevalence rates for meeting criteria for DMDD ranged from 0.8% to 3.3%, with the highest rate in preschoolers
  • Rates dropped slightly with the strict application of the exclusion criterion, but they were largely unaffected by the application of onset and duration criteria
  • Highest levels of co-occurrence were with depressive disorders and ODD
  • Disruptive mood dysregulation occurred with another disorder 62%–92% of the time (questions diagnostic boundaries) -> many don’t like DMDD because of the high comorbidity
  • Affected children displayed elevated rates of social impairments, school suspension, service use, and poverty
63
Q

Describe the validity of DMDD

A
  • Validity of diagnosis not firmly established
  • Newer diagnosis in the DSM
  • Research is mixed about the construct validity of DMDD -> what’s DMDD compared to other disorders
  • Risk of over-diagnosis
  • Irritability is an important construct in child psychopathology in general
64
Q

Describe the issue with categorical depression diagnoses

A
  • DSM is a categorical system -> either have MDD or you don’t
  • Many children and adolescents have subclinical depression -> won’t quite make diagnostic criteria, but have a significant number of symptoms, show significant impairment (ex: academic, social), and are at greater risk for developing depression and other disorders and difficulties
  • Diagnosis gives access to treatment and care -> just because someone doesn’t meet the criteria for a disorder doesn’t mean they wouldn’t benefit from treatment
65
Q

What are the lifetime prevalence rates for MDD?

A
  • 1% of preschool-aged children (3-5)
  • 2% of elementary school-aged children (5-12)
  • 11% of adolescents (13-18) - Increasing rates across development for children and adolescents
  • Big jump in prevalence rates from childhood to adolescence -> depression becomes more common as you move into adolescence
66
Q

What are racial/ethnic differences in rates of depressive disorders among youth?

A
  • Latin youth more likely than White youth to meet diagnostic criteria for a mood disorder
  • Evidence that Black youth experience greater levels of mood disorders than White youth
  • White youth more likely than both Latin and Black youth to have received treatment for a mood disorder
  • Suspects for differences: minority group overrepresentation in low SES groups, exposure to discrimination (interpersonal, systemic, cultural), etc.
67
Q

What are gender differences in rates of depressive disorders among youth?

A
  • Lack of differences in childhood (~11-13yrs old)
  • Differences become pronounced in adolescence
  • No one variable explains the difference
  • Starting in adolescence (~15) and onward, girls are much more likely to meet criteria for a mood disorder than boys
68
Q

What are some possible explanations for gender gap in rates of depressive disorders among youth?

A
  1. Girls are more likely to seek help
  2. Biological factors
  3. Stress & Interpersonal Stress
  4. Cognition
  5. Coping
69
Q

Describe the “girls are more likely to seek help” explanation for gender gap in rates of depressive disorders among youth

A
  • NCS-A: No gender difference in use of services for depression
  • Gender difference is found in community samples (girls with significant symptoms of depression are more likely to seek treatment than boys with depressive symptoms)
70
Q

Describe the “biological factors” explanation for gender gap in rates of depressive disorders among youth

A
  • Biological and hormonal changes leading to increased rates of depression in girls
  • Onset of elevated rates of depression in girls coincides with puberty
  • More mature pubertal status is linked to depression in girls, but not boys -> stronger predictor than age
  • Early onset puberty is a risk factor for depression in girls -> puberty may sensitize girls to stress (making them more vulnerable to the negative impacts of stress)
71
Q

Describe the “stress & interpersonal stress” explanation for gender gap in rates of depressive disorders among youth

A

Stress
- Puberty may create stressors for girls -> changes in physical appearance and sex-role/gender identity identification
- Robust link between stress and depression (stress is a strong predictor of depression)

Interpersonal Stress
- Conflict with friends, rejection by peers
- Girls are more likely to generate interpersonal stress than are boys
- Stronger association between interpersonal stress and depression for girls than for boys
- Girls are more invested in interpersonal relationships -> may make it so that there’s more room for interpersonal conflict
- Girls and women are more likely to fall victim to assault or harassment and women are overrepresented in lower SES conditions

72
Q

What are the core features of autism?

A
  • Impairment in communication
  • Impairment in social interaction
  • Repetitive patterns of behaviors and interests
73
Q

What’s social communication disorder?

A
  • Defined by difficulties in social communication
    1) Deficits in communication for social purposes
    2) Impairment of ability to change contexts to needs of listener (ex: speaking differently to a child rather than an adult)
    3) Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, knowing how to use verbal/non-verbal signals to regulate interaction
  • Restricted, repetitive patterns of interest have never been present -> If you’ve ever had criterion B from ASD or were diagnosed with ASD, then you’re ruled out a diagnosis of social communication disorder
74
Q

What are factors that differentiate ID from ASD?

A

Children with ID have:
- No specific deficit in joint attention
- No specific deficit in theory of mind
- No specific deficit in pretend play
- Social behaviors appropriate for their mental age

75
Q

What’s the extinction paradigm?

A
  • US: Danger
  • UR: Fear
  • CS: Dog
  • CR: Fear
  • CS-: CS presented in the absence of the US
  • Repeated exposure to CS- will extinguish the relationship between CS and CR
76
Q

Describe the Graded Exposure Hierarchy

A
  • List anxiety triggers
  • Rate each trigger
  • “Subjective Units of Distress” from 0-10
  • May use a Mood Thermometer (faces) with young children
  • Rank order triggers (organize from easiest to hardest tasks and build a good ladder)
77
Q

What are the treatment goals for OCD?

A

(1) Normalize OCD and Intrusive Thoughts with CBT
(2) Exposure and response prevention

78
Q

What were the findings of the POTS study for OCD?

A
  • CBT vs Placebo and combined vs placebo was much more effective at the UPenn site
  • At Duke, combined group is doing better than CBT and meds
  • At Penn, combined group is not doing better than CBT
  • Explanation: could be that Upenn was giving high quality CBT
  • If you can get really good CBT, there may not be an added benefit of also taking medication
79
Q

What were the findings of the CAMS study?

A
  • Moderator: Anxiety diagnoses
  • Combined is associated with best outcomes across all 3 diagnoses
  • Social anxiety disorder: SSRI > CBT
  • GAD: CBT > SSRI
80
Q

Describe the Treatment Strategy of Applied Behavior Analysis (ABA) for ASD

A

(1) Discrete Trial Training
- Structured behavioral approach
- Therapist begins with a prompt that should elicit the desired skill/behavior (show me the 2! Show me the pretzel!)
- Prompt the behavior
- Positively reinforce the desired behavior
- Shaping
(2) Reinforcing naturally occurring behaviors
- Read a story and reinforce use of language
- Video glossary at autismnavigator.com
- Treatment, Behavioral, Discrete Trial
- Training and Lovaas Method of Applied Behavior Analysis

81
Q

Describe the impairment in communication we see in ASD

A
  • ~ 50% of children with autism do not develop any useful language (sophisticated, articulate, verbal language skills)
  • Qualitative language impairments (ex: echolalia (compulsively repeating what others say), perseveration (getting stuck on a topic), impairments in pragmatics (when context isn’t accounted for)
  • May see these in varying degrees)
82
Q

Describe the impairment in social interaction we see in ASD

A
  • Qualitative impairment in social interaction
  • Ex: social imitation, joint attention (ability to coordinate attention of a social partner to an object
    -> use this to facilitate playing), expressive nonverbal behavior, reciprocity, social “mind” (difficulty thinking of others as beings that we socially engage with frequently, may not seek out those interactions as much)
  • Difficulty with Theory of Mind (ToM)
83
Q

Describe Klin (2000) study on impairment in social interaction in ASD

A
  • Had teens with and without autism watch the old short film of shapes moving around
  • Studies have used this film to demonstrate how we always look for social interactions even in abstract things
  • People usually describe this video as bullying
  • Teens without autism described the video as bullying -> gave abstract film a story
  • Teens with autism described literally what they saw in the film -> lack of social story for youth with ASD
84
Q

What’s Theory of Mind (ToM)?

A
  • Knowing that others have mental states (desires, beliefs, intentions) and that that state guides their behaviour
  • ToM helps with perspective thinking and helps us with our responses
  • At ~ age 4, most children are able to demonstrate theory of mind reliably
  • By 4 years old, only 20% of children with ASD have developed ToM
  • Often assessed via False belief tasks -> taking ToM and developing an understanding of others’ perspective
85
Q

Describe Repetitive Patterns of Behaviors & Interests in ASD

A
  • Self-stimulation (stereotyped repetitive movements, often involve one or more senses)
  • Intense, narrow interests
  • Rigid routines (disruption of routines can be very dysregulating for children with ASD)
  • Preoccupation with parts of objects
86
Q

What are the different theories for self-stimulation behaviours in ASD?

A
  • Neurological craving for stimulation to excite their nervous system
  • A way of blocking out and controlling unwanted stimulation from environment that is too stimulating (overstimulation)
  • Maintained by sensory reinforcement it provides
87
Q

What have eye-tracking studies for children with and without ASD found?

A
  • When watching tv and movies, where do the eyes go?
  • Typically-developing children tend to focus on faces a lot
    ○ Faces give lots of verbal information
    ○ Especially look at the eyebrows, lips, eyes, which convey lots of social info
  • Children with ASD spend less time looking at socially latent info when looking at faces of people -> ex: look at the chin
  • Children with ASD also more likely to look in the periphery (ex: looking at the light switch) instead of social info
88
Q

What’s some evidence for a dimensional spectrum in autism?

A
  • Within diagnosis, severity of symptoms vary
  • Symptoms can vary widely among children with ASD
  • Within diagnosis, language ability varies
  • Within diagnosis, any level of IQ possible
  • Presence of traits in close relatives below threshold
89
Q

How was autism presented in the DSM-IV?

A
  • DSM-4 had a few different disorders which are now grouped under one disorder: ASD
  • Autistic disorder – social interaction; restrictive/repetitive interests, language deficits
  • Asperger’s disorder - social interaction; restrictive/repetitive interests, often above average IQ
  • Pervasive Developmental Delay not otherwise specified (PDD-NOS) -> people with difficulties in social interactions and showing repetitive behaviours without necessarily having ASD or asperger’s
90
Q

How is ASD assessed?

A
  • Autism Diagnostic Observation Schedule (ADOS)
  • ADI-R – Autism Diagnostic Interview (revised)
91
Q

Describe the ADI-R – Autism Diagnostic Interview (revised)

A
  • Often paired with ADOS
  • Interview with parents/caregivers of child suspected of having ASD
92
Q

Describe Autism Diagnostic Observation Schedule (ADOS)

A
  • Gold standard assessment tool used for ASD
  • Widely used in the diagnosis of ASD
  • Semi-structured observation
  • Lots of different tasks
  • Testing things like looking for pointing, pretend play and language
  • Not pointing to things is a red flag for ASD
  • Presses
  • A certain pattern of behavior is likely to appear
  • We know that children with autism are likely to behave a certain way
  • Ex: unstructured presentation of toys
  • Scoring what happens
  • Often paired with other information (background interview, ADI, etc.)
93
Q

Why is the term Asperger’s controversial?

A

Hans Asperger, the psychiatrist for whom the disorder was named, was associated with/sympathetic to the ideals of the Nazi party

94
Q

Describe the prevalence of Autism

A
  • Prevalence of autism is 1 - 1.5%
  • Prevalence has increased over time (actual increase in number of children who have autism vs. Better identification and broader definitions?)
  • ASD is prevalent cross-culturally
  • Large variation in diagnostic practices among different countries
95
Q

Describe gender differences in autism

A
  • 4:1 male to female ratio
  • 10:1 male to female ratio in “high functioning” ASD
96
Q

Describe the developmental course of autism

A
  • Most often identified by parents in the months preceding child’s 2nd birthday
  • Diagnoses made around 2 - 3 yrs are generally stable across time
  • Some children display symptoms since birth
  • Some children seem to lose early developmental milestones
  • Usually lifelong
  • Variability in trajectories of children with ASD (people meet criteria at different levels throughout heir lifespan)
97
Q

What are the strongest predictors of better adult outcomes with autism?

A
  • Better language skills
  • Higher IQ
98
Q

What are some examples of possible early identification tests for ASD?

A
  1. Using eye tracking to see what toddlers are looking at - Toddlers with autism focus on geometric rather than social images
  2. Brain enlargement
    - Recent data indicate that rate of cortical surface expansion between 6 and 12 months predicts diagnosis of autism at 24 months (Hazlett et al. 2017)
99
Q

Describe the comorbidity of ASD

A
  • 70% of youth with autism
    meet criteria for ID
  • 40% meet criteria for severe or profound ID
  • 25% have “splinter skills” (ex: spelling, reading drawing -> skill above others in the population)
  • 5% are considered savants (gifted/genius) -> display isolated and remarkable talents (can grow out of these skills)
  • Other comorbid conditions: epilepsy (fairly common in kids with ASD) and ADHD, conduct problems, anxiety disorders, depression
100
Q

Describe the first IQ test

A
  • First IQ test developed in France by Alfred Binet and Theophile Simon
  • French government commissioned them to develop a way to identify school children who might need special help in school
  • Developed the Stanford-Binet scale -> first intelligence test and very popular
101
Q

Describe IQ testing and eugenics

A
  • IQ testing was seen by eugenicists as a way to identify people who they thought should not be allowed to have children
  • Forced sterilizations based off genetic tests and used to stigmatize certain ethnic, racial and religious groups
  • Subsequent development of IQ tests was racist, testing culturally based knowledge and test-taking proficiency
  • During this time, people identified as having lower intellectual functioning were put in institutions and sterilized without their consent -> usually Black, Indigenous, and poor
102
Q

What are cognitive abilities?

A
  • Set of mental processes which improve and degrade over the course of development in the lifespan
  • They’re under the umbrella of intelligence
103
Q

What’s intelligence?

A

A measured quantity which summarizes a person’s ability to apply knowledge and skills in diverse situations

104
Q

What’s the Psychometric Approach to intelligence

A
  • Paradigm or way of thinking that the main intelligence tests are based off of
  • Spawned the development of standardized tests of intelligence
  • Contrasted crystallized vs. fluid intelligence
  • Developmental progression of 2 different types of intelligence (crystallized and fluid)
105
Q

What’s crystallized intelligence?

A
  • Use of knowledge acquired through schooling and other experiences
  • Ex: do you know facts? Do you know multiplication? Division?
  • Crystallized intelligence tends to just go up over time, fairly linearly -> because you learn more facts and more about the world as you grow older
106
Q

What’s fluid intelligence?

A
  • Ability to use your mind to solve novel problems
  • Fluid intelligence shows increases through childhood and adolescence into and through young adulthood but once people start to age (around mid-life and beyond), we tend to see slight declines in fluid intelligence
107
Q

What’s mental age?

A
  • A lot of early IQ tests were interested in measuring mental age
  • The level of age-graded problems that a child or person is able to solve
    ○ Ex: readings levels -> when someone says “this person can read at a 7th grade level”
    ○ If you give numerous tasks to numerous people across the lifespan, there will be a range
    ○ Ex: the average 15 yr old can answer these types of problems at this level of difficulty, but doesn’t do well at a harder level of difficulty
    ○ What’s the average or typical thing that someone of each age could do?
  • If you’re younger and can do tasks typical for someone of an older age, then you would have an older mental age than your biological or chronological age
  • Ex: if typical for 17 yr olds to do trigonometry and a 10 yr old can do trigonometry, then the 10 year old has a mental age of 17
  • Simon-Binet intelligence test used the mental age tests
108
Q

What’s general intelligence (g)?

A
  • Underlying level of intelligence
    ○ Everyone has this underlying level of intelligence
    ○ Not something we can measure directly (ex: no blood test or specific tests to directly measure g)
    ○ G is just a part of someone and is in some ways unobservable
  • Researchers try to measure g by thinking what are the different broad abilities that might make up someone’s general intelligence? What are the different domains of your intelligence?
    ○ Ex: fluid and crystallized intelligence -> general intelligence causes you to have a certain level of fluid intelligence and a certain level of crystallized intelligence
109
Q

What’s the hierarchical view of intelligence?

A
  • General ability (g) -> broad abilities (cognitive domains - ex: fluid or crystallized intelligence) -> specific abilities (specific test and error - intelligence tests)
  • IQ tests are located at the bottom of the hierarchy
  • By engaging in specific tasks, researchers think these are indicative of what level you have in a specific domain of intelligence
  • Performance on those tasks gives a sense of how strong you are in each domain of intelligence which gives us a hypothesis of your level of g (general intelligence)
  • Arrows are going down: general intelligence is influencing how one performs in each domain, and performance in these domains influences how well one scores on different tasks attempting to measure these domains
110
Q

What are the different Wechsler Scales?

A
  • WPPSI-III (pre-schoolers)
  • WISC-V (kids 6-18)
  • WAIS-IV (18+)
111
Q

What are the primary index scales of the Wechsler Intelligence Scales for Children (WISC)

A
  • Verbal comprehension (similarities & vocabulary)
  • Visual spatial (block design & visual puzzles)
  • Fluid reasoning (matrix reasoning & figure weights)
  • Working memory (digit span & picture span)
  • Processing speed (coding & symbol search)
112
Q

How do the WISC primary index scales play into the hierarchical view of intelligence?

A
  • Hierarchical view of intelligence -> ex: g -> verbal comprehension -> similarities and vocabulary
  • The primary index scales are the specific domains from the hierarchical psychometric approach to intelligence
  • Based on this test, your general intelligence or full-scale IQ score is made up of your scores across these 5 different domains
  • Within each of these primary index scales/domains, there are 2 specific tasks that measure your performance in that domain
113
Q

How do we calculate the full-scale IQ from tests from all domains?

A
  • Use test norms
  • Standards of your performance expressed as an average of scores and the range of scores around your average
  • Based on the performance of a large, representative samples
  • Averages based on age
  • Not based off how many you get right (not the raw score), it’s based on an age curve
114
Q

Describe the normal curve for IQ scores

A
  • Standard deviation (measure of how tightly the scores are clustered around the mean score)
  • Full scale IQ: average in population is 100
  • Average for 7, 18 and 78 yr olds is 100
  • Nearly 95% have scores between 70 and 130
  • Fewer than 3% have scores of 130 or above -> criterion of giftedness
  • Fewer than 3% have
    scores below 70 -> DSM-IV general cutoff for intellectual disability
115
Q

Describe the Stability of IQ Scores during Childhood

A
  • Around age 4, fairly strong relationship between early and later IQ
  • Many children show ups and downs in their IQ scores over course of childhood
  • IQ scores influenced by Motivation, Testing procedures, Intelligence
  • Correlations are stronger when retested at a closer age
  • Infant IQ is pretty unrelated to later IQ -> not very predictive of later IQ
  • Except for kids with moderate-severe intellectual disability
116
Q

What are some reasons for racial-ethnic disparities in IQ scores?

A
  • Bias in the tests
  • Environmental differences among groups (family characteristics and SES differences)
  • Stereotype threat (fear that you’ll be judged to have negative stereotypes associated with one’s group)
  • Not due to genetic differences between groups –> race isn’t genetic, it’s socially constructed
117
Q

What did Gonthier (2022) find about cultural differences in IQ testing?

A

Found that we see cultural differences in visuo-spatial (visual non verbal tests) as well as verbal tests, because groups process things differently which may lead to tests being culturally biased for or against specific groups

118
Q

What’s successful intelligence?

A
  • Under Sternberg’s theory, successful intelligence allows one to…
  • Establish and achieve reasonable goals
  • Optimize your strengths and minimize weaknesses
  • Adapt to the environment
  • Use and demonstrate intelligence in all 3 components of intelligence (creative, practical and analytic)
119
Q

Describe Sternberg’s Triarchic Theory of Intelligence

A
  • Goes against the psychometric approach
  • Not necessarily very hierarchical
  • Intelligence arises from a combination of 3 components
  • 3 types of intelligence: creative, practical, analytic
  • Creative: effectively dealing with novel problems and automating responses to familiar problems (includes creating, inventing, discovering, imagining)
  • Practical: “street smarts”, successfully solving problems that arise in everyday life (includes adapting to environment you’re in, selecting environments in which you can succeed, and shaping your environment to fit your strengths)
  • Analytic: selecting mental processes that’ll lead to success, thinking critically and analytically (includes planning, evaluating, analyzing, monitoring, comparing & contrasting, filtering info)
120
Q

Describe Gardner’s Theory of Multiple Intelligences

A
  • Gardner rejects IQ score as a valid measure of human intelligence
  • Argues for 8 different dimensions of intelligence
  • These 8 different dimensions aren’t hierarchical
  • Not that your different intelligences add up to some general intelligence, you just have a different level of intelligence in different domains
  • No overarching intelligence
  • Not focused on how smart are you (psychometric approach), focused on how are you smart, in what areas are you smart?
  • Some people think that savant syndrome is consistent with Gardner’s theory of multiple intelligences
121
Q

What intelligence tests are used in clinical assessment?

A

WISC, Stanford-Binet, etc. based on psychometric approach + hierarchical view of intelligence

122
Q

The change from DSM-IV of defining IDD by adaptive functioning and intellectual functioning is in relation to what?

A

Relation to Flynn Effect (IQ scores rising overtime across cultures) and effect of rebalancing on IQ
distribution

123
Q

What was the DSM-5-TR clarification on Criterion A of intellectual functioning in IDD?

A

Even though there is no longer clear cut-offs for IQ in ID anymore, still probably wouldn’t find ID in people with IQs significantly above 65-75 IQ range

124
Q

Describe the organic etiology of IDD

A
  • Includes chromosome abnormalities, single gene conditions, and neurobiological influences
  • Tend to be moderate, severe, and profound
  • Prevalence comparable across SES groups
125
Q

Describe the cultural/familial etiology of IDD

A
  • Doesn’t have a clear cause
  • Includes family history of IDD, economic deprivation, inadequate child care, poor nutrition, and parental psychopathology
  • Most cases tend to be mild cases
  • Higher rates in lower SES families
126
Q

What are the specific organic syndromes linked with chromosomal abnormalities?

A
  • Most common cause of severe ID
  • Down syndrome (chromosome/trisomy 21, most cases are random events)
  • Prader-Willi and Angelman (chromosome 15, most cases are random events)
  • Fragile-X syndrome (X chromosome, inherited)
127
Q

What are the specific organic syndromes linked with single-gene problems?

A
  • Phenylketonuria (PKU; inherited)
  • Single gene polymorphism (single gene mutism that happens in people)
  • Cannot metabolize amino acid phenylalanine, rising levels are toxic and impact intellectual development
128
Q

What are the specific organic syndromes linked with neurobiological injury?

A
  • Prenatal - during pregnancy (ex: Fetal Alcohol Syndrome)
  • Perinatal - during birth (ex: anoxia at birth)
  • Postnatal - during developmental window (ex: head injury)
129
Q

What are the characteristics displayed with Down syndrome?

A
  • 15-20% of population with ID has Down Syndrome
  • Underlying symbolic abilities (understanding symbols, abstract meaning behind things) of children are believed to be largely intact
  • Considerable delay in expressive language development -> expressive language is weaker than receptive language
  • Fewer signals of distress or desire for proximity with primary caregiver (ex: strange situation task -> no clear signs of distress when separated from caregiver)
  • Delayed, but positive, development of self-recognition
  • Delayed and aberrant functioning in internal state language -> reflects emergent sense of self and others
  • Social skills deficits that may lead to peer rejection
130
Q

What are the most common psychiatric diagnoses for children with Down syndrome?

A
  • Impulse control disorders (ex: ODD), anxiety disorders,
    and mood disorders
  • Internalizing problems and mood disorders in adolescence are common
131
Q

What are some common Emotional and Behavioral Problems in children with intellectual disability?

A
  • ADHD-related symptoms
  • Pica is seen in serious form among children and adults with ID
  • Self-injurious behavior (SIB)
132
Q

What’s the most common health condition for IDD?

A
  • Epilepsy (then Cerebral Palsy, then Anxiety Disorder)
  • Over 20% of youth with ID have epilepsy (seizure disorder)
133
Q

What is lead paint associated with?

A

Linked with increased risk for ID

134
Q

Which group of children are early education programs most beneficial for?

A
  • Low SES youth may particularly benefit from these early education programs
  • Large gaps in amount of receptive language a kid is exposed to
  • Early childhood programs especially targeted towards lower SES groups, to help these kids get language input from somewhere else to reduce disparities that we see in input and exposure to language

Child Dev: Psychopathology (9 decks)

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