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3009PSY Abnormal > week 5 > Flashcards

week 5 Flashcards

1
Q

Childhood Disorders

Overview

A

General Diagnostic Skills
E.g., Differential Diagnosis

Neurodevelopmental Disorders
E.g., Autism Spectrum Disorder

Externalizing Disorders
E.g., Oppositional Defiant Disorder

Internalizing Disorders
E.g., Anxiety

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2
Q

General Diagnostic Skills

Developmental Psychopathology

A

Cannot know what is pathological in children and adolescents without knowing what is normal and healthy!

Cannot know what is going on without doing a differential diagnosis!

Abnormality as defined by deviation to normal function can be examined using the Childhood Milestones sheets

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3
Q

Differential Diagnosis

A

Differential diagnosis - differential diagnosis is the initial set of possible diagnoses you must consider before settling on a definitive diagnosis

“Just because something looks like a condition, does not mean it is”

Work along with other relevant specialists:
-GP, Paediatrician, Child Psychiatrist, Speech Pathologist, Occupational Therapist, Teachers

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4
Q

Neurodevelopmental Disorders

A

Intellectual Disability

Communication Disorders

Autism Spectrum Disorder

Attention-Deficit/Hyperactivity Disorder

Specific Learning Disorder

Motor Disorders

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5
Q

how many neurodevelopmental disorders?

A

6

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6
Q

DSM-V Neurodevelopmental Disorders

A

Group of related but different conditions varying from specific problems (e.g., planning) to global problems (e.g. social skills) with onset in the developmental period before the child enters grade school!

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7
Q

Neurodevelopmental Disorders

Intellectual Disability

A

DSM-V Neurodevelopmental Disorders1.Intellectual Disability

Intellectual disability (intellectual development disorder) – characterised by deficits in:
  -General mental abilities – reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience

Severity – mild, moderate, severe, profound ( DSM-V)

Global developmental delay – an individual fails to meet expected milestones in several areas of functioning

Differential diagnosis – does the individual have a genetic (Down Syndrome) or a medical condition (cerebral palsy)?

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8
Q

Neurodevelopmental Disorders

Communication Disorders

A

Communication disorders include:

  • Language disorder
  • Speech sound disorder
  • Social (pragmatic) communication disorder
    • All characterised by deficits in the development and use of language (spoken words, written words, sign language, pictures), speech (fluency, voice, articulation) and social communication (verbal or nonverbal that influences behaviour, ideas or attitudes).
  • Childhood-onset fluency disorder (stuttering)
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9
Q

DSM-V Neurodevelopmental Disorders2. Communication Disorders

A

Differential diagnoses: nationality (language), hearing impairments, neurological disorders (epilepsy), selective mutism (based in anxiety), dysarthria (due to cerebral palsy), sensory deficits, medication, tourette’s disorder, social anxiety etc

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10
Q

Neurodevelopmental Disorders

Autism Spectrum Disorder

A

Autism Spectrum Disorder – characterised by persistent deficits:

  • Social communication and social interaction across multiple contexts
  • Requires presence of restricted, repetitive patterns of behaviour, interests or activities

Severity:

  • Level 3 – requiring very substantial support
  • Level 2 – requiring substantial support
  • Level 1 – requiring support

Differential diagnosis – consider Rett Syndrome (neurodevelopmental disorder characterized by normal development and sudden loss of purposeful use of hands slowed brain growth problems walking, intellectual disability and more), selective mutism, language disorders, stereotypic movement disorder, ADHD, schizophrenia

 – no diagnosis of Aspergers any longer (must meet Criteria for Autism Level 1)

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11
Q

Removal of Aspergers from DSM-V

A

Can I or my child retain the diagnosis of Asperger syndrome?
Many individuals may wish to retain their previous diagnosis as the label is considered part of their identity or may reflect a peer group with whom they identify. This is perfectly acceptable. A clinician can indicate both the DSM-5 diagnosis as well as the previous diagnosis, such as Asperger syndrome, in an individual’s clinical record.

The DSM-5 text states “ Individuals with a well-established DSM-IV diagnoses of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder”.

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12
Q

Neurodevelopmental Disorders

Motor Disorders

A

Motor Disorder – include:

Developmental Co-ordination Disorder - clumsiness and slowness or inaccuracy of performance of motor skills

Stereotypic Movement Disorder – purposeless motor behaviour (hand shaking or waving, body rocking, head banging, self-biting)

Tic Disorders – tourettes disorder (vocal tics), persistent(chronic) motor or vocal tic disorder

Differential diagnosis – cerebral palsy, autism, ADHD, OCD, genetic conditions (Huntington’s disease), encephalitis etc

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13
Q

Neurodevelopmental Disorders

Specific Learning Disorder

A

Specific Learning Disorder – is defined by specific deficits in an individuals’ ability to perceive or process information efficiently and accurately. Impairments include:

  • Reading – accuracy, fluency, comprehension
  • Written expression – spelling, grammar, clarity, organisation
  • Mathematics – number sense, memorisation, calculation, reasoning
  • Specify: Mild, Moderate, Severe
  • Differential diagnosis – normal variations in academic abilities, vision impairment, hearing impairment, ADHD, etc
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14
Q

Externalizing Disorders

A

Behaviour problems directed toward external world

Characterised by failure to control behaviour according to the expectations of others

The most commonly diagnosed childhood disorders

ADHD, oppositional defiant disorder (ODD), conduct disorder (CD)

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15
Q

DSM-V Neurodevelopmental/Externalising Disorders1. ADHD

ADHD(considered neurodevelopmental (1 of the 6))

A

Attention-Deficit Hyperactivity Disorder – is defined by impairing levels of:
–Inattention and disorganisation – inability to stay on task, seeming not to listen, and loosing materials

–And/or hyperactivity-impulsivity – over-activity, fidgeting, inability to stay seated, inability to wait

Differential diagnosis – oppositional defiant disorder, intermittent explosive disorder, depression, bipolar disorder, reactive attachment disorder, learning disorder, substance use

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16
Q

Attention-Deficit Hyperactivity Disorder (ADHD)

criterion

(innattention)

A

`A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:

Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted
Is often forgetful in daily activities.

17
Q

Attention Deficit Hyperactivity Disorder (ADHD)

HYPERACTIVITY AND IMPULSIVITY:

A

HYPERACTIVITY AND IMPULSIVITY: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often “on the go” acting as if “driven by a motor”.
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting his/her turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games)

18
Q

ADHD - Types

A

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

1) Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
2) Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
3) Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well

19
Q

Attention Deficit Hyperactivity Disorder (ADHD)

diagnosis decision making

A

Deciding if a child has ADHD is a several-step process. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms.

20
Q

Treatment of ADHD

A

Pharmacotherapy

Stimulant medications. 1991 – 1995 the number of 15-19 yr olds treated with Ritalin jumped 311% in USA

Methylphenidate (Ritalin) & Dextroamphetamine - Increase availability of dopamine

Short term effectiveness – long term outcomes questionable

Medication targets hyper-activity and impulsivity, more so than inattention

Side effects – decreased appetite, increased HR, sleeping difficulties, retarded growth

21
Q

Treatment of ADHD

behaviour management

A

Behaviour Management - Behavioural Family Intervention (been around since the 60’s), Triple P (Sanders, 1999), Incredible Years (Webster-Stratton, 1990)

  • Parent training in behaviour management strongest evidence base
  • Increasing desirable behaviour and reducing noncompliance
  • Training in contingency management – rewards & consequences – token economies
  • Quiet time, time out, planned ignoring
  • Parental expectations, appropriate commands, consistency & routine
  • Child problem solving, social skills, & learning to self-soothe
  • School accommodations and teacher use of attention & praise

Behaviour Management (potentially with added medication) is without a doubt the most long-term effective treatment to date!

22
Q

Externalizing Disorders

Oppositional and Conduct Disorders

A
  1. Oppositional Defiant Disorder – angry/irritable mood (e.g., is resentful); argumentative/defiant behaviour (e.g., blames others); or vindictiveness
  2. Conduct Disorder – pattern of behaviour where basic rights of others are violated. Examples: aggression to animals or people, destruction of property, deceitfulness or theft, serious violations of rules
    - –is a strong predictor of adult criminal behaviour

Differential diagnosis: adjustment disorder, depression ADHD, anxiety, intellectual impairment

Note: There is also something called Intermittent Explosive Disorder – recurrent behavioural outbursts (verbal aggression & destruction to property

23
Q

Internalizing Disorders

A

Anxiety

OCD

Trauma

Depression

Disruptive, Impulse-Control, and Conduct Disorders

24
Q

Classification of Internalizing Disorders

A

Internalising disorder:

  • -Psychological / emotional problems directed inward
  • -Involve the child’s internal world – thoughts, feelings
25
Q

Internalizing Disorders

OCD

A

Obsessive-Compulsive Disorder
Obsessions – “sticky” thoughts (children speak differently to adults…>)
Compulsions – checking, repetitive behaviours
Skin picking
Hair pulling
Hoarding

PANDAS– pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (post-infection autoimmune disorder) characterised by the sudden onset of obsessions, compulsions, tics
Controversial diagnosis

26
Q

Internalizing Disorders

Trauma and Stress

A

Reactive Attachment Disorder – inhibited and emotionally withdrawn behaviour toward adult caregiver + social & emotional disturbance

Disinhibited Social Engagement Disorder – a child actively approaches and interacts with unfamiliar adults

Differential diagnosis – autism, depression, intellectual impairment

27
Q

Internalizing Disorders

Depression

A

Children may experience significant and persistent irritability rather than sadness

Poor agreement between parents and children – generally

Developmental variation in presentation

  • Under 2 – unresponsiveness to caregivers
  • Preschoolers – sad expression & social withdrawal
  • School – somatic complaints, awareness of sadness
  • Youth – full-blown depression, suicidal ideation and intent
28
Q

Internalizing Disorders

Anxiety

A

Anxiety Disorders
–Separation anxiety – excessive distress when anticipating or experiencing separation from home or major attachment figures

Selective Mutism – consistent failure to speak in social situations (this is most likely an avoidance strategy used to avoid speaking in public – i.e., social phobia)

Specific phobia – marked anxiety about a specific object (needles, blood, insects)

Social anxiety – fear of scrutiny of others, worry of humiliation or embarrassment

Generalised anxiety – excessive anxiety and worry about a number of events or activities

In children, the fear of anxiety may be expressed as crying, tantrums, freezing, clinging, shrinking or failing to speak in social situations

29
Q

Normal Developmental Fears and link to anxiety an adulthood

A

Infancy – strangers, loud noises
Early childhood – separation, monsters, darkness
Middle childhood – real-world dangers, injury, new challenges
Adolescence – social status, performance, health

NORMAL FEARS can lead to ANXIETY DISORDERS
Fear of Thunder – Avoid – Problem Fixed
Fear of negative social evaluation – Avoid – Problem Fixed
Fear of negative evaluation at work place – Avoid – Problem Fixed

30
Q

DSM-V Other Disorders 1. Elimination Disorders

A

Elimination Disorders – involve the inappropriate elimination of urine or faeces

  • Enuresis – repeated voiding of urine into inappropriate places (into bed or clothes) – during day or night or both
  • Encopresis – repeated passage of faeces into inappropriate places (into clothing or floor) – may involve constipation and/or overflow incontinence

^^ likely to go away with time

(But what are the costs of waiting for spontaneous remittance? How would you feel, think, behave if wetting yourself at 12?)

Differential diagnosis – medical conditions (diabetes, urinary tract infection), medicine, stress, diarrhoea etc.

31
Q

Other Disorders

A

Elimination Disorders

Feeding and Eating Disorders

32
Q

Developmental Psychopathology

A

Disorders are defined by syndrome’s (collection of symptoms) versus individual symptoms (remember lecture 1?)
Balance between risk and protective factors important in predicting outcomes (See DSM-V – provides information on this)
Risk – things that can make the situation worse (alcoholic parents, parents with mental health difficulties,)
Protective factors – anything that reduces the situationfrom becoming worse (social support, healthy coping)
Example: child with learning disorder and father can’tread and mum is not interested in child (risks to situation)

33
Q

Other issues - school refusal

A

School Refusal

  • “difficulty attending school associated with emotional distress, especially anxiety and depression” King & Bernstein (2001)
  • “child-motivated refusal to attend school or difficulties remaining in school for the entire day” (Kearney & Silverman, 1996)
Fears:
- Separation from parents
-Tests, academic performance, -school work
-Bullying, social concerns
-Specific classes/teachers
-New school/transition
Bullying and Cyberbullying
34
Q

DSM-V Other Disorders 2. Feeding & Eating Disorders

A

Pica– involves eating non-nutritive, non-food substances (soap, paper, hair)
Rumination Disorder – repeated regurgitation of food (re-chew, re-swallow or spit out)

Differential diagnosis – autism, schizophrenia, Kleine-Levin Syndrome (neurological disorder), intellectual impairment

For children, it can be due to neglect, lack of supervision, developmental delay, lack of stimulation, stressful life situations

35
Q

Internalizing Disorders–

Trauma & Stress-Related Disorders

A

Post-Traumatic Stress Disorder – exposure to actual or threatened death, serious injury or sexual violence

Acute Stress Disorder - exposure to actual or threatened death, serious injury or sexual violation (symptoms last 3 days to 1 month)

Adjustment Disorder - begins within 3 months and lasts up to six (going to school, leaving a parent, grief and loss)

Differential diagnosis – autism, depression, intellectual impairment

36
Q

Causes of Internalising Disorders

A 
Genetic predisposition
Conditioning & Trauma & Learning
--Modelling
---Reinforcement
--Stressful / traumatic events
Family Factors
Cognitive factors
--Thinking style
--Explanatory style

3009PSY Abnormal (11 decks)

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