1 Developmental Psychopathology
Studies disorders within context of normal child development
2 Relationship between child and adult psychopathology
-Some disorders are unique to children (separation anxiety disorder)
-some are primarily childhood disorders, but may continue in adulthood (ADHD)
-Some are present in children and adults (Depression)
3 DSM-5 Childhood Disorders
split into 2 CHAPTERS:
-Neurodevelopmental Disorders
-Disruptive, Impulse Control, and Conduct Disorder
NEW NAMES for disoders:
-Mental Retardation ->Intellectual developmental disorder
COMBINE some disorders
-Autistic,\
-Asperger's ---------------Autism
4 Externalizing Disorders
-Characterized by outward-directed behaviors
-Noncompliance, aggressiveness, overactivity, impulsiveness
-Includes attention-deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder.
-More Common in Boys
5 Attention Deficit/Hyperactivity Disorder
-Excessive Levels of Activity (Fidgeting, squirming, running around when inappropriate, incessant talking)
-Distractibility and Difficulty Concentrating (Makes careless mistakes, cannot follow instructions, forgetful)
-National ADHD Awareness Day (Septemb
6 Proposed DSM-5 Criteria For ADHD
Six or more manifestations of either INATTENTION or HYPERACTIVITY present for at least 6 months to a maladaptive degree and greater than what would be expected given a person's developmental level.
-Inattention: Careless mistakes, not listening well, not
7 Three Subcategories of ADHD (DSM-IV-TR)
1.) Predominantly inattentive type
-poor attention predominates
-Most common in girls
2.)Predominantly hyperactive-impulsive type
-Hyperactivity and impulsivity are primary
3.)Combined type
-Both hyperactivity and inattention are prominent
-Most common
8 ADHD Vs Conduct Disorder
ADHD
-More off-task behavior, cognitive and achievement deficits
Conduct Disorder
-More aggressive, act out in most settings, antisocial parents, family hostility
-50% of children with ADHD also meet diagnostic criteria for conduct disorder
9 ADHD Facts
-often comorbid with anxiety and depression
-Prevalence estimates 3 to 7% worldwide
-More common in boys than girls (May be because boys' behavior more likely to be aggressive)
-Symptoms persist beyond childhood
--Numerous longitudinal studies show 65 to
10 Hinshaw et al. (2006)
large, ethnically diverse study of girls
-Combined type
-Inattentive type
Girls with ADHD more likely to:
1-Be anxious and depressed
2-Exhibit neurological deficits (e.g., poor planning, problem-solving)
3-Have symptoms of eating disorder and substance ab
11 Hinshaw Combined and Inattentive Type
Combined Type:
1-More disruptive behaviors than inattentive type
2-More comorbid diagnoses of conduct disorder or oppositional defiant disorder than girls without ADHD
3-Viewed more negatively by peers than inattentive type or girls without ADHD
Inattenti
12 Etiology of ADHD
1-Genetic Factors
2-Neurobiological Factors
3-Perinatal and Prenatal Factors
4-Environmental Toxins
5-Parent-Child Relationship
13 Etiology of ADHD: Genetic Factors
1)Adoption and Twin Studies
2)Two Dopamine Genes implicated
a-DRD4 (Dopamine Receptor Gene)
b-DAT1 (Dopamine Transporter Gene, mixed support for it)
-Either gene associated with increased risk only when prenatal maternal nicotine or alcohol use is present
14 Adoption and Twin Studies
-Heritability estimates as high as 70 to 80%
-When parents have ADHD, 50% of their children also have ADHD
-Concordance for clinically diagnosed hyperactivity in 51% of MZ twins and 33% DZ twins
15 Etiology of ADHD: Neurobiological Factors
-Dopaminergic areas smaller in children with ADHD (Frontal lobes, caudate nucleus, globus pallidus)
-Poor performance on tests of frontal lobe function
16 Etiology of ADHD:Perinatal and Prenatal factors
Low birth weight
-Can be mitigated by later maternal warmth
Maternal tobacco and alcohol use
17 Etiology of ADHD: Environmental Toxins
-Limited evidence that food additives or food coloring can have a small impact on hyperactive behavior
-No evidence that refined sugar causes ADHD
-Nicotine from maternal smoking
18 Environmental Toxins: Nicotine from Maternal Smoking
-Exposure to tobacco in utero associated with ADHD symptoms
-May damage dopaminergic system resulting in behavioral disinhibition
19 Etiology of ADHD: Parent-Child Relationship
-Parents give more commands and have more negative interactions
-Family factors
--Interact with genetic and neurobiological factors
--Contribute to or maintain ADHD behaviors but do not cause them
20 Treatment of ADHD
1-Stimulant Medications
2-Medication plus behavioral treatment
3-Psychological Treatment
4-Supportive Classroom Functioning
21 Stimulant Medications
(Ritalin, Adderall, Concerta, Strattera)
-Reduce disruptive behavior
-Improve interactions with parents, teachers, peers
-Improve goal-directed behavior and concentration
-Reduce aggression
-Side effects
-a) loss of appetite
-b) Weight
-c) sleep problems
22 Medications + Behavioral Treatment
MTA Study
-Slightly better than meds alone
-Improved social skills whereas meds alone did not
-Three-year follow-up found superior benefits of meds did not persist
23 Psychological Treatment
-Parental training
-Change in classroom management
-Behavior monitoring and reinforcement of appropriate behavior
24 Supportive Classroom Structure
-Brief assignments
-Immediate feedback
-Task-focused style
-Breaks for exercise
25 Conduct Disorder
Pattern of engaging in behaviors that violate social norms, the rights of others, and are often illegal
1-Aggression
2-Cruelty towards other people or animals
3-Damaging property
4-Lying
5-Stealing
6-Vandalism
7-Often accompanied by viciousness, callousne
26 Substance Abuse Common in Conduct Disorder
Unclear whether it precedes or is concomitant with disorder
27 Conduct Disorder Comorbid with Anxiety and Depression
-Comorbidity rates vary from 15 to 45%
-CD precedes anxiety and depression
28 Oppositional Defiant Disorder (ODD)
behaviors do not meet criteria for CD (especially extreme physical aggressiveness) but child displays pattern of defiant behavior
-Argumentative
-Loses temper
-Lack of compliance
-Deliberately aggravates others
-Hostile, vindictive, spiteful, or touchy
-B
29 Proposed DSM-5 Criteria for Conduct Disorder
Repetitive and persistent behavior pattern that violates the basic rights of others or conventional social norms as manifested by the presence of three or more of the following in the previous 12 months and at least one of them in the previous 6 months:
a
30 Two Types of Conduct Disorder
Moffit, 1993
-Life-course-persistent pattern of antisocial behavior
(10 - 15x more common in boys than girls)
-Adolescence-limited (Maturity gap between physical maturation and rewarding adult behaviors)
-Follow-up longitudinal studies of life-course-pers
31 Etiology of Conduct Disorder
-Venn Diagram: Social, Psychological, Neurobiological
1-Genetic Factors
2-Neurobiological Factors
3-Psychological Factors
4-Dodges Cognitive Theory of Aggression
5-Peer Influences
6-Sociocultural Factors
32 Etiology of CD: Genetic Factors (5)
1-Heritability likely plays a part
2-Twin study data show mixed results
3-Adoption studies focused on criminal behavior, not conduct disorder
4-Meta-analysis of twin and adoption studies suggest 40 to 50% of antisocial behavior is heritable (Genetics a st
33 Etiology of CD: Neurobiological Factors (4)
1-Poor verbal skills
2-Difficulty with executive functioning
3-Low IQ
4-Lower levels of resting skin conductance and heart rate suggest lower arousal levels
34 Etiology of CD: Psychological Factors (5)
1-Deficient moral development, especially lack of remorse
2-Modeling and reinforcement of aggressive behavior
3-Harsh and inconsistent parenting
4-Lack of parental monitoring
5-Cognitive bias: Neutral acts by others perceived as hostile
35 Etiology of CD: Dodge's Cognitive Theory of Aggression
Ambiguous act
interpreted as hostile---> Aggression Towards others
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36 Etiology of CD: Peer Influence
-Rejection by peers
-Affiliation with deviant peers
37 Etiology of CD: Sociocultural Factors
-Poverty
-Urban Environment
-Higher rates of delinquent acts among African American males linked to living in poorer neighborhoods rather than race
38 Treatment of Conduct Disorder
1-Family Interventions
2-Multisystematic Therapy
39 Family Interventions
-Family check-ups (FCU) associated with less disruptive behavior
-Parental management train (PMT)
-Teach parents to reward prosocial behavior
40 Multisystematic Therapy
Deliver intensive community-based services
41 Internalizing Disorders
-Characterized by inward-focused behaviors
--Depression, anxiety, social withdrawal
-Includes childhood anxiety and mood disorders
-More common in girls
42 Depression and Anxiety in Children and Adolescents
-Commonly co-occur with ADHD and CD
-Also co-occur with each other
-Early research suggested that depression and anxiety could be distinguished from each other in the same way they are in adults:
--Depression - high negative affect, low positive affect
--
43 Depression in Children and Adolescents
-Symptoms common to children, adolescents, and adults
1-Depressed mood
2-Inability to experience pleasure
3-Fatigue
4-Problems concentrating
5-Suicidal ideation
-Symptoms Specific to Children and adolescents
1-Higher rates of suicide attempts and guilt
2-
44 Etiology of Depression in Children and Adolescents
-Genetic factors
-Early adversity and negative life events
-Family and relationship factors
-Cognitive distortions and negative attributional style
-Stable attributional style
45 Etiology of Depression: Family and Relationship Factors
-A parent who is depressed
-Parental rejection only modestly associated with depression
-Children with depression and their parents interact in negative ways
--Less warmth
--More hostility
46 Etiology of Depression: Stable Attributional Style
-Develops by early adolescence
-By middle school, attributional style serves as a cognitive diathesis for depression
47 Treatment of Depression in Children and Adolescents
-Medications
-Concerns about Medications
-Interpersonal psychotherapy (IPT)
-Cognitive Behavioral Therapy (CBT)
48 Medications
-SSRIs more effective than tricyclics
-Meta-analysis showed medications most effective for anxiety other than OCD
--Less effective for depression and OCD
49 Concerns about Medications
-Side effects including diarrhea, nausea, sleep problems, and agitation
-Possibility of increased risk of suicide attempts
50 Interpersonal psychotherapy (IPT)
Focuses on peer pressures, transition to adulthood, and issues related to independence
51 Cognitive Behavioral Therapy
-More effective for Caucasian adolescents, those with pretreatment, good coping skills, and recurrent depression
-Psychotherapy generally only modestly effective with children and adolescents
--CBT no better than non-CBT therapies
52 Anxiety In Children and Adolescents
-Fears an worries common in childhood
-Anxiety disorder
-Most childhood fears disappear, but adults with anxiety disorders report feeling anxious as children ("I've always been this way")
-Prevalence
53 Prevalence of Anxiety Disorder in Children and Adolescents
3-5% of children and adolescents diagnosed with it
54 Anxiety Disorders in Children
-Separation Anxiety Disorder
-Social Anxiety Disorder
-PTSD
-OCD
55 Separation Anxiety Disorder
-Worry about parental or personal safety when away from parents
-Typically first observed when child begins school
56 Social Anxiety Disorder
Extremely shy and quiet
May exhibit selective mutism
-Refusal to speak in unfamiliar social setting
Prevalence
-1% of children and adolescents
Etiology
-Overestimation of threat
-Underestimation of coping ability
-Poor social skills
57 PTSD in Children
Exposure to trauma
-Chronic physical or sexual abuse
-Community violence
-Natural disasters
58 PTSD Symptom Categories
-Flashbacks, nightmares, intrusive thoughts
-Avoidance
-Negative cognitions and moods
-Hyperarousal and vigilance
Some symptoms may differ from adults
-May exhibit agitation instead of fear or hopelessness
59 OCD in Children
Prevalence 1 to 4%
Symptoms similar to those in adults
Most common obsessions:
-Contamination from dirt and germs
-Aggression
-Thoughts about sex and religion more common in adolescence
more common in boys than girls
60 Etiology of Anxiety Disorders
-Genetics
-Parenting plays a small role in anxiety disorders
--Only 4% of variance
-Emotion regulation and attachment problems also play a role
-Perception of lack of acceptance by peers a factor in social phobia
-Risk factors for PTSD
61 Etiology of Anxiety: Genetic Factors
-Heritability estimates from 29 - 50%
-Genetics plays a stronger role in separation anxiety in context of more negative life events
62 Risk Factors for PTSD
-Family stress and coping style
-Past experience with trauma
63 Treatment of Anxiety Disorders in Childhood and Adolescence
Exposure to feared object
-Reward approach behavior
CBT Kendall's Coping Cat program
64 Cognitive Behavioral Therapy Kendall's Coping Cat program
Shows to be effective in two randomized clinical trials
For childern between 7 and 13 years old
-Cognitive restructuring
Develop new ways to think about fears
Psychoeducation
Modeling and exposure
Skills training and practice
Relapse prevention
Family inv
65 Intellectual Developmental Disorder
-Significantly below average intellectual functioning (IQ less than 70)
-Deficits in adaptive functioning
--Self-care, communication, home living, decision making, etc.
-Onset before age 18
-Most professionals focus on strengths of individual to assess ab
66 Intellectual Developmental Disorder formerly known as Mental Retardation in DSM-IV-TR
-Not preferred due to stigma
-Followed the guidelines of the American Association on Intellectual and Developmental Disabilities (AAIDD)
67 The AAIDD Definition of Intellectual Disability
-Intellectual disability is characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills
-This disability begins before age 18
-Five Assumptions Essent
68 DSM-5 Criteria for IDD
-intellectual deficits (eg in solving problems, reasoning, abstract thinking) determined by intelligence testing & broader clinical assessment
-Significant deficits in adaptive functioning relative to person's age or cultural group in 1 + of the following
69 IDD: DSM-5 Changes
-There is explicit recognition that an IQ score must be considered within the cultural context of a person
-Adaptive functioning must also be assessed and considered within the person's age and cultural group
-No longer distinguish among mild, moderate, a
70 Etiology of IDD: Neurological Factors
-Down syndrome
-Fragile-X syndrome
-Recessive Gene Disease
-Maternal infectious disease, especially during first trimester
-Lead or mercury poisoning
71 Down syndrome
-Chromosomal trisomy 21: an extra copy of chromosome 21
-47 instead of 46 chromosomes
72 Fragile-X syndrome
Mutation in the fMRI gene on the X chromosome
73 Recessive Gene Disease
Phenylketonuria (PKU)
-a baby is born without the ability to properly break down an amino acid called phenylalanine.
74 Maternal infectious disease, especially during first trimester
Cytomegalovirus, toxoplasmosis, rubella, herpes simplex, HIV, and syphilis
75 Treatment of IDD
-Residential treatment
-Behavioral treatments
-Cognitive treatments
-Computer-assisted instruction
76 Residential treatment
Small to medium-sized community residences
77 Behavioral treatments
-Language, social, and motor skills training
-Method of successive approximation to teach basic self-care skills in severely retarded
--e.g., holding a spoon, toileting
-Applied behavioral analysis
78 Cognitive Treatments
Problem-solving strategies
79 Autism
Repetitious or stereotyped behaviors (at least 1 of the following
-Abnormal preoccupation with objects
-Ritualized behaviors
-Body rocking hand flapping
-Stereotyped mannerisms
-Abnormal preoccupation with parts of an object
Begins before age 3
More often
80 Characteristics of Autism
-Extreme autistic aloneness
-Communication problems
-Preservation of sameness (insistence on sameness; resistance to change)
--React violently to any change in routine. If you say hi and one day say hey
-Self-stimulation
-stereotypical behavior, ritualist
81 Characteristics of Autism: Communication Problems
Mutism (50%)
-Lack of language
Echolalia
-Child speaks, but only repeats verbatum what they have heard.
Pronoun Reversal
-Some relationship to inability to differentiate themselves from others (what did you have for breakfast? "she had cereal")
82 Autism Spectrum Disorder DSM-5 changes
combine multiple diagnoses into one: Autism Spectrum Disorder
-Autistic disorder, Asperger's disorder, pervasive developmental disorder not otherwise specified, and childhood disintegrative disorder
-Research did not support distinctive categories
-Share
83 Proposed DSM 5 Criteria for Autism Spectrum Disorder
Total of 6+ items from either A,B, or C below: 2 from a, 1 each from B and C
A: Deficits in social communication and social interactions
B: Restricted, repetitive behavior patterns, interests, or activities
C: Onset in Early Childhood
D: Symptoms limit an
84 A: Deficits in Social Communication and Social Interactions
Manifested by all of the following:
-deficits in nonverbal behaviors such as eye contact, facial expression, body language
-deficit in development of peer relationships appropriate to developmental level
-deficits in social or emotional reciprocity such a
85 B: Restricted, repetitive behavior patterns, interests, or activities
Manifested by at least 2 of the following:
-Stereotyped or repetitive speech, motor movements, or use of objects
-Excessive adherence to routines, rituals in verbal or nonverbal behavior, or extreme resistance to change
-very restricted interests that are
86 Autism Spectrum Disorder
1-Profound problems with the social world
2-Theory of mind
3-Communication deficits
4-Repetitive and ritualistic acts
87 profound problems with the social world
-Rarely approach others, may look through people
-Problems in joint attention
-Pay attention to different parts of faces than do people without autism; focus on mouth, neglect eye region
-This neglect likely contributes to difficulties in perceiving emoti
88 Theory of Mind
-Understanding that other people have different desires, beliefs, intentions, and emotions
-Crucial for understanding and successfully engaging in social interactions
-Typically develops between 2� and 5 years of age
-Children with ASD seem not to achieve
89 Communication Deficits
-Children with ASD evidence early language disturbances
-Echolalia
-Pronoun reversal
Literal use of words
90 Echolalia
immediate or delayed repeating of what was heard
91 Pronoun Reversal
Refer to themselves as "he" or "she
92 Repetitive and ritualistic acts
-Become extremely upset when routine is altered
-Engage in obsessional play
-Engage in ritualistic body movements
-Become attached to inanimate objects (e.g., keys, rocks)
93 Comorbidity of ASD
IQ < 70 is common
-Children with intellectual developmental disorder score poorly on all parts of an IQ test; children with ASD score poorly on those subtests related to language, such as tasks requiring abstract thought, symbolism, or sequential logic
94 Prevalence of ASD
-1 out of 110 children
-Found in all SES, ethnic, and racial groups
-Diagnosis of ASD is remarkably stable
95 Prognosis of ASD
-Children with higher IQs who learn to speak before age six have the best outcomes
96 Etiology of Autistic Spectrum Disorder
-Genetic factors
-Neurobiological Factors
97 Etiology of ASD: Genetic Factors
heritability estimates of around .80
Twin studies
-47 to 90% concordance rates for MZ twins;
-0-20% for DZ twins
Genetic flaw
-Deletion on chromosome 16
98 Etiology of ASD: Neurobiological Factors
Brain size
-Although normal size at birth, brains of autistic adults and children are larger than normal
-Pruning of neurons may not be occurring
-"Overgrown" areas include the frontal, temporal, and cerebellar, which have been linked with language, socia
99 limbic system
-developmentally more immature.
-More neurons but they are very small.
- Brain of person with ASD looks like a much younger person in this section
100 Cerebella Circuits
has a number of cell populations that are missing in people with ASD
101 Treatment of Autistic Spectrum Disorder
-Psychological treatments more promising than drugs
-Earlier treatment associate with better outcomes
-Intensive operant conditioning (Lovaas, 1987)
--Dramatic and encouraging results
-Parent training and education
-Pivotal response treatment (Koegel et a
102 Pivotal response treatment (Koegel et al., 2003)
Focus on increasing child's motivation and responsiveness rather than on discrete behaviors
103 Medication
used to treat problem behaviors
-Haloperidol (Haldol)
--Antipsychotic
--Reduces aggression and stereotyped motor behavior
--Does not improve language and interpersonal relationships