Test 1 Flashcards
October 1, 2024
Understanding child psychopathology is a complex endeavor. Explain three reasons why it is so challenging to study this field and three reasons why child psychopathology is an area worth studying?
3 reasons why it’s challenging:
1: Many childhood problems are not narrow in scope/expression (and cannot be attributed to one cause)
2: Most forms of psychopathology in kids overlap with other disorders
3: Conceptualization/definition of psychopathology in kids is vigorously debated
stigma
3 reasons why it’s worth studying:
1: Can influence policy makers by drawing attention to issues in the youths
2: As many as 1/3 of US kids experience some sort of difficulty
3: Majority of kids w/ mental health issues that go unassisted end up in the criminal justice/mental health systems as YA.
What are some “risk markers” for child psychopathology? What do these tell us about adopting a single-cause etiological perspective?
Risk markers
1: genetic influences
2: temperament
3: insecure child-parent attachments
4: social-cognitive deficits
5: deficits in social learning
6: emotional regulation/dysregulation
7: effortful control
8: neuropsychological/biological dysfunction
9: maladaptive patterns of parenting and maltreatment
10: parental discord
What do these tell us about adopting single-cause etiological factor?
Research does not support recognizing any single risk central etiological status
Distinguish between and give examples of externalizing and internalizing problems. What gender-related patterns do we see?
Externalizing: aggression and conduct problems / behaviors directed outward
example: rule-breaking, substance use, hyperactivity, fighting
Internalizing: behaviors directed inward/are overcontrolled
example: perfectionism, depression, anxiety
Gender-related patterns:
Boys exhibit higher levels of externalizing patterns than girls through childhood and adolescence. Girls: internalizing. But in early childhood, both are comparable in terms of internalizing symptoms.
What is the “gender paradox of comorbidities”?
Although the prevalence of disruptive behavior is lower in females than males, the risk of COMORBID conditions is higher in females.
Why? Interpersonal sensitivity heightened level
What would you say in response to this statement, “distinguishing between normal and abnormal is useless. Diagnoses are just human-made language-based categories that have no basis in reality.” (in Mash and Barkley, this was in a section that compared distinguishing that “line” between normal and abnormal to distinguishing the line between night and day.) This is a useful metaphor. Can you describe it?
Describe some of the cross-cultural patterns discussed in chapter 1, keeping in mind that cultural differences can impact the expression of behavioral patterns in children and the interpretation or meaning adults assign to these.
Can you give an example of 2 separate research findings that illustrate the expression and one research finding that illustrates the interpretation or meaning adults assign? (a total of 3)
Cross cultural patterns:
Rural vs urban: few differences
Native American: higher rates of suicide, substance abuse
AA/Hispanic: less likely to receive services, higher externalizing in AA likely due to SES
Research finding, 1: 1989 study, overcontrolled problems reported significantly more for Jamaican than American youth: consistent w/Afro-British Jamaican cultural attitudes discouraging aggression and other undercontrolled behavior, instead fostering overcontrolled behavior.
Research finding, 2: ratings of behavior/emotional problems, 2-9 year olds, Thailand, US. Thailand: rated both overcontrolled/undercontrolled as less serious, worrisome. Cultural differences in meanings ascribed to prob. behaviors
Keeping in mind that the range or limits of normal behavior expression can be quite broad, what are some ways of determining whether a child’s behavior falls inside or outside of that range? See Wilmhurst and the four Ds. Be able to apply these to a brief sample case if given one.
Determining how a child’s behavior is abnormal or normal:
Wilmhurst and the 4 Ds
1. Deviance
2. Dysfunction
3. Distress
4. Danger
If you were asked “how many kids are affected by a mental health condition?” what would you say? (see Mash and Barkley reference to Costello et al, 2003 and the authors’ argument that those figures are likely an underestimate. Be able to explain some of the factors involved in estimating numbers.)
As many as 1/3 of children in the US experience some sort of difficulty. Estimate; probably more.
Factors in estimations:
1. Underestimating impact of psychopathology in youth - adults with psychopathology likely had it as youth?
- Many conditions do not meet formal diagnostic criteria but are still associated with dysfunction
- Recent conditions may have placed children at increasing risk for the development of disorders
Studying child psychopathology requires also studying adaptive child development as well. Why is this so? Name five reasons (see Mash and Barkley pp. 17-18 and PPT from our second class meeting. Note that we were short on time and did not talk through all of these, but I have summarized them for you there.
5 reasons to study adaptive child development (positive child development)
- We need a point of reference. Behavior compared to baseline.
- Problematic behavior often in children not completing other developmental tasks
- Presenting problems = connected to other important behaviors (ADHD, peer relationships)
- Most children experience “ups and downs” in problem types/intensity
- Behaviors that don’t meet diagnostic threshold may still signal problems
Developmental continuities and discontinuities have to do with how “long” problems persist (i.e., whether children “grow out of them” as is typically the case with enuresis or “bedwetting”). It also has to do with whether mental disorders look the same or different over time (i.e., the expression of symptoms). Mash and Barkley list some possible “mechanisms” to explain difficult early experiences/behavior and later disordered behavior, classifying these as direct and indirect. Give two examples of each (see pp 18-19) making sure that you explain these in such a way that it is clear you understand them (i.e., avoid simply writing a word or two).
Mechanisms explaining difficult early experiences/behavior and later disordered behavior
Direct
- Development of a disorder during infancy/childhood that persists over time
- Experiences altering an infant’s or child’s physical status which then influences later functioning - example: neural plasticity
Indirect
- Experiences altering self-esteem/creating a negative cognitive set
- Early predispositions that interact with the environment to produce dysfunction
Equifinality and multifinality are terms we often see associated with childhood development. Can you describe what these mean and offer an example of each (see page 20 and feel free to do a google search if it would help)?
Equifinality: different experiences leading to same outcomes on the developmental pathway
example - parental divorce -> childhood depression
Multifinality: similar experiences leading to different outcomes on the developmental pathway
example - child sexual abuse -> negative outcomes not experienced by some
Mash and Barkley note that there are some proponents who argue that mild to moderate stress exposure may benefit children. While the research on this is still developing, what is the rationale behind this idea?
Can you give an example of how this might manifest for a child? (see bottom of p 21 to top of p 22)
How could mild to moderate stress benefit children?:
Stress enables children to develop coping/other skills that allow them to navigate future stressors more successfully
Example: Stress from starting at a new school prepares child for transition into college and other new experiences
Mash and Barkley discuss protective and vulnerability factors that can be “located” within the child, the family system, and the community. Give an example of one protective factor and one vulnerability factor that would be found at each level (so you would provide a total of three protective factors and three vulnerability factors –6 factors all together).
Child protective factor: easy temperament (cuddly, etc) makes them appealing to other people
Family system protective factor: close relationship with at least 1 caregiver
Community protective factor: effective school environment
-
Child vulnerability factor: genetic risk has moderate associations between adversity and negative outcomes
Family system vulnerability factor: perinatal stress
Community vulnerability factor: community disasters
What do Mash and Barkley mean when they talk about “adaptational difficulty” or “adaptational failure”?
deviation from age appropriate norms, failure to master developmental tasks/mechanisms, use of non-normative skills like rituals to adapt to traumatic experiences
Looking at page 28, the authors provide a table that lists neurodevelopmental disorders and disorders that are often diagnosed in infancy, childhood, or adolescence. Then on the next page is another table that lists conditions that may be a focus of clinical attention. Be able to give three examples from each table.
Neurodevelopmental Disorders
1. Intellectual disabilities
2. Autism Spectrum Disorder
3. ADHD
Infancy, Childhood, Adolescence
1. Depressive disorders
2. Anxiety disorders
3. Feeding and eating disorders
Other Conditions, Clin. Attn
1. Abuse and neglect
2. Housing and economic problems
3. Relational problems
Distinguish between dimensional approaches to diagnosis and categorical approaches to diagnosis. A brief description is fine. This is one of those topics you see discussed/debated in almost all psychology textbooks related to psychopathology/diagnosis.
Dimensional approaches: focus on symptom clusters/syndromes from behavior problem checklists (Achenbach Behavior Checklist)
Categorical approaches: use predetermined diagnostic criteria to define the presence or absence of disorders (DSM 5)
Define comorbidity. How common is it?
Psychiatric, psychological, social disorders, or difficulties that most co-exist with the disorder
Pervasive between internalizing and externalizing disorders. High.
Briefly describe the attachment perspective. Give two examples of research findings that are foundational to this lens.
Attachment perspective: emphasizes the importance of early relationships and how they provide the foundation for development
Research 1: Bowlby 1988, Goldberg 1991 - early attachment quality -> developing internal working models carried into later relationships
Research 2: Cicchetti & Manly 2001, physically abused children -> insecure attachments -> view interpersonal relationships as coercive and threatening -> solve problems with aggression
On the bottom right of page 42, Mash and Barkley distinguish between cognitive deficits and cognitive distortions. Briefly describe what these mean. How does that translate into the conceptualization of internalizing and externalizing behaviors (top of 42 right column)
Cognitive deficits: absence of thinking where it would be beneficial. Leads to externalizing.
Cognitive distortions: thinking is biased, dysfunctional, misguided. Leads to internalizing and some suggest possible to externalizing as well.
On page 43, the authors discuss the role of defense mechanisms in psychodynamic theory. If you are not familiar with these, take a look at this page. Give two examples of how a person (could be an adult or child) would use a defense mechanism to manage anxiety/distress. How are these adaptive and maladaptive (basically a simple pros and cons explanation is sufficient)
Defense mechanisms: thought patterns and behavior that serve function of regulating emotional experiences too difficult to manage at the conscious level. Avoid, minimize, convert emotion
- A man with anxiety about his mother’s terminal illness is in denial about prognosis.
*pros: avoids pre-mourning
*cons: is not prepared - A traumatized child dissociates from their reality
*pros: finds an escape
*cons: is not comfortable living in the present
Distinguish between emotion reactivity and emotion regulation. Describe these as they relate to children
Emotional reactivity: individual differences in the threshold and intensity of the emotional experience (emotional arousal) - can inhibit, facilitate, or disrupt behavior.
A child throws a tantrum and says hurtful things to another child because they are using their favorite toy.
Emotional regulation: processes that operate to control or modulate reactivity
Instead of throwing a tantrum because another child is using their favorite toy, a child uses their words to ask for a turn
While neuroimaging offers fascinating clues about the role of biological factors in mental health diagnoses, what are the limitations of this technology at this time?
Limitations: cannot predict treatment response or other important clinical outcomes like age of onset. Biological, not psychological or behavioral.
Mash and Barkley describe the role of twin studies and adoption studies in teasing out genetic contributions. They also discuss monozygotic (MZ) and dizygotic (DZ) twins. Briefly explain how this research approach can help us understand the roles of nature and nurture. If you would like a refresher, visit the Michigan State University Twin Study Registry page.
Nature vs nurture
How differences emerge at the level of the brain
MZ: same genetic material/identical/from 1 egg
DZ: from 2 eggs, “fraternal” twins
Twin studies: examine genetic contribution to a genetic trait - environment can also come into play i.e, twins raised apart, twins in different situations, etc
In terms of child psychopathology, what is risk and in what way is risk a quantitative concept?
Risk: Multifaceted potential of a negative psychological outcome
Quantitative: allostatic load (wear and tear of the biological and psychological systems due to stressors), ACEs (measurable experiences), risk factors (measurable risks)
Compas and Andreotti classify or group together different resilience factors according to whether they are (a) individual factors, (b) environmental factors, or (c) whether they reflect an interplay of both. Can you think of examples for each of those categories? Make sure you can describe how the ones you name fit into one (or more categories) and how they might interact with other factors.
Individual resilience factors:
1. Temperament
2. High IQ
3. Good communication skills
Environmental resilience factors:
1. Effective school environment
2. 1 positive relationship w/a mentor/caregiver - Hawaii study, 70s
3. Good family environment
Then on test, describe and examine interactions
In the Compas and Andreotti chapter, the authors define stress and talk about the role of cognitive appraisal.
What does cognitive appraisal mean? Give some examples.
Address why this research doesn’t seem to apply as well to children? (see p. 147)) It is clear that stressful events along with “chronic sources of adversity” (p. 148) contribute to the development of both internalizing and externalizing problems. The direct mechanisms are unclear at this point, and we tend to think of these as “non-specific risk factors.”
Research examining sexual abuse, however, shows a more specific connection to what three things?
Also, in what way is “allostatic load” a useful construct for thinking about stress in children?
Cognitive appraisal: perception of what is, or isn’t, stressful in the environment
Example: ferris wheel operator
1) A person who thinks the operator looks drunk or out of it might be afraid to go on the ferris wheel
2) A person who thinks the operator just looks bored will not be afraid
Not as applicable to children because children look to adults to interpret environmental clues
(Window sill slapping example)
Sexual abuse: connection to internalizing, PTSD, sexual acting out symptoms
Allostatic load: wear and tear on bio. systems, useful to think about stress in children because it (…)
Can you define emotion regulation with your own words in a way that captures the complexity of the construct? How do children learn to regulate their emotions? Give an example of up-regulation and down-regulation. Note what the authors say about “emotional approach coping.” In what way can you envision this being useful with children and/or adults?
Emotional regulation is being able to identify/track the feelings coming up inside you, and process them in a way that shows situational awareness.
Children learn from parents
Up regulation: gratitude journal
Down regulation: deep breath
Emotional approach coping: expressing emotions to deal with stress (journal, draw it out). Useful for children who don’t know how to articulate it - can draw instead?
Cognitive restructuring – what is this? Can you give some examples? (feel free to dig beyond the article). What does the research say about cognitive restructuring? On this same page, the authors talk about less adaptive strategies to coping. Describe these. Here’s a tough question: How is cognitive restructuring different from thought suppression? Could someone argue they are the same thing? Why or why not?
Cognitive restructuring: efforts to reinterpret events in neutral tones. Reframing instead of repressing. Not the same thing.
Less adaptive coping strategies: internalizing - perfectionism? - turning to consumption of food or alcohol etc - externalizing: aggression, etc
Focusing on the material related to depression (starting p. 154), how “big” of a problem is depression as we think about population health? What are the trends for childhood/adolescence? What are the implications for children if parents experience depression? In what ways is parental depression hard on children. Create a list (or better yet, a diagram if you are able!) of the ways that parental depression impacts child adjustment and development.
Big problem: depression is common; 50-80% of offspring from depressed parents likely meet criteria for psych disorder by YA. Highly recurrent.
Trends: 15-16 peak age for MDD diagnosis, women have increased risk during YA and child-bearing years
Parents w/depression: children rate higher for internalizing AND externalizing disorders, symptoms worsen as the child ages, 2x - 3x risk of depressive disorder
Conduct disorder requirements - behavioral clusters
Aggression to people and animals
Destruction of property
Deceitfulness or theft
DSM-5-TR identifies two onset types for conduct disorder: childhood and adolescent. Which best describes childhood-onset type?
Symptoms begin before the age of 10 and are usually more severe
T or F: boys are more likely than girls to be diagnosed with CD during childhood, but the rates between boys and girls, evening out during adolescence
F
CD commonly comorbid with
ADHD
Briefly describe 2 environmental factors associated with CD
- Inconsistent discipline and harsh punishment
- Abuse/parental hostility
Research suggests that children with CD show abnormalities in which brain structure?
Prefrontal cortex
Callous-Unemotional Traits
Lack of empathy
Worse prognosis
CD treatment
CBT
Family treatment
Motivational interviewing
Parental factor, CD
Inconsistent discipline and harsh punishment
Disorder most important to rule out while diagnosis CD due to similarities?
ODD - oppositional defiant disorder
Which statement is TRUE about the relationship between CD and SubAb?
CD often leads to early SubAb and dependence
Which outcome most likely in adulthood for individuals who had childhood-onset CD, especially w/out early intervention?
Development of antisocial PD
ODD does not have
Violent outbursts leading to physical harm
Symptoms must persist for how long for an ODD diagnosis?
6 months
Which is true regarding developmental trajectory of ODD
May develop into CD if left untreated, esp. in children with severe symptoms
ODD comorbid w/
ADHD
True or false: callous-unemotional traits are commonly associated with ODD and predict worse long-term outcomes
T
ODD causes impairment in
Social, academic ,and family
According to the DSM-5, which of the following is a key criterion for diagnosing a SUD in adolescents
Continued substance use despite significant personal or social problems
Which mental health disorder is most commonly comorbid w/sub use adolescent?
OCD
Which of the following statements is true regarding the onset of substance use in adolescence?
Earlier the onset, higher the likelihood of of developing a SUD later in life
Risk markers for substance abuse (other conditions)
GAD
PTSD
Social anxiety for ADULT use only
Which of the following is accurate regarding gender differences in adolescent substance abuse?
In general, substance use is less pronounced in girls
Girls use fewer types of drugs
Use them less frequently
Consume less alcohol in a single setting
What is a protective factor against adolescent substance abuse?
High parental involvement and monitoring
Screening for adolescent SUD
CRAFFT Screening Tool
Highest risk of overdose and fatality
Opiods
ADHD and CD brain prt
Prefrontal cortex
At what age must ADHD symptoms be present?
Before 12
How does setting come into play? (more than one needed) - ADHD
Must be present in multiple settings
Academic, social, executive functioning impairment
What are the three presentations? ADHD
Combined type: meets both inattentive and hyperactive/impulsive for the past 6 months
Predominantly inattentive type: meets inattentive, but not hyperactive/impulsive criteria for the past 6 months
Predominantly hyperactive/impulsive: meets hyperactive/impulsive requirements for the past 6 months but not predominantly inattentive type
What are four symptoms associated with inattention? ADHD
Poor listening skills
Loses/misplaces items
Diminished attention span
Avoids or is disinclined to begin activities requiring attention
What are four symptoms associated with hyperactivity and impulsivity?
Difficulty waiting turn (I)
Interrupts (I)
Difficulty staying in seat (H)
Over Talkative (H)
What is the time frame in terms of how long symptoms should be present? adhd
6 months
Ratio of boys to girls? ADHD
2:1 - may be underreported for girls
Developmental stability over time? ADHD
Chronic, symptoms may change over development
May have adverse outcomes: poor educational outcomes, poor health outcomes, but many report healthy and happy lives
If a parent brings a child to you for an ADHD diagnosis, what would you want to do in order to gather information?
Look for impaired functioning in more than one setting, no specific psychological or neurological tests
How many symptoms are needed to assign the ODD diagnosis?
4
ODD: List at least 5 of the 8 symptoms cited in the DSM associated with distress or other impairment
Angry/irritable mood
Loses temper
Easily annoyed
Angry and resentful
Argumentative/defiant behavior
Argues w/authority figures
Refuses to comply w/authority
Blames others for mistakes or behavior
Vindictiveness
Spiteful or vindictive at least 2x within the past 6 ms
Disturbance of behavior associated with distress or other impairment
How long do ODD symptoms need to be evident?
6 months
What are the three categories or clusters of behaviors listed for ODD?
Angry/Irritable Mood
Argumentative w/defiant behavior
Vindictiveness
What is the age that divides the two subtypes based on onset? CD
Childhood onset - before 11, more severe
Adolescent onset - after 11
How many symptoms need to be present to diagnose CD?
3/15
The DSM lists 15 symptoms for CD. Can you list 5 of them?
Aggression to People and Animals
Bullies, threatens, intimidates others
Has used a weapon
Has forced someone into sexual activity
Destruction of Property
Deliberate fire setting
Deceitfulness or Theft
Has broken into someone else’s house/building/car
Has stolen items of nontrivial value without confronting victim
Serious Violation of Rules
Has run away from home overnight at least 2x
Often truant before age 13
What is the timeframe involved in evaluating symptoms if you are looking at diagnosing CD? (i.e., what does the DSM require?)
At least 3 symptoms for at least 12 months
Describe what is meant by Callous-Unemotional Traits. What is its relationship to CD?
CU= lack of empathy. CD is evaluated with respect to Callous-Unemotional Traits.
How many symptoms are needed within what timeframe to diagnose SUD?
2 or more in a year
SUD Previous DSM conceptualization versus current DSM?
Had two separate categories: substance use and substance dependence: now there’s only 1
There are 10 symptoms listed for SUD. Can you list five of these?
1: taking more of the substance than intended
2: desire and/or attempts to cut down
3: craving
4: excessive time spent using/acquiring/recovering
5: giving up hobbies to use
There are three SUD categories (mild, moderate, severe) The number of symptoms is what comprises each category, so mild is 2-3, moderate is 4-5, severe is 6 or more.
There are three categories (mild, moderate, severe) The number of symptoms is what comprises each category, so mild is 2-3, moderate is 4-5, severe is 6 or more.
Poly-drug use is common with SUD. What are the most common combinations?
Alcohol + marijuana
Alcohol & hallucinogens
In children/youth, what diagnoses are frequently comorbid with SUD?
OCD and ODD
The COVID pandemic had what impact on substance use among young people? What has been the result since the pandemic? What area is of major concern?
Went down, stayed down, but fentanyl deaths went UP
Looking at the SUD PPT, there is a slide about two questions to ask children and youth regarding substance use as a screen. The wording and order varies by age, but basically, what are the two questions getting at? Note that this screener is targeting primary care settings in addition to mental health treatment.
Do your friends drink, or do you?
How much?
