Kring Chapters 13, 15 Reviewer PDF

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LT IV Reviewer Chapter 13 – Disorders of Childhood - Psychological disorder diagnosis among children have increased greatly, but not without controversy o Antipsychotic medications also increased fivefolds between 1993 and 2002 13 Classification and Diagnosis of Childhood Disorders - Identify what i...

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LT IV Reviewer

Chapter 13 – Disorders of Childhood - Psychological disorder diagnosis among children have increased greatly, but not without controversy o Antipsychotic medications also increased fivefolds between 1993 and 2002 13.1 Classification and Diagnosis of Childhood Disorders - Identify what is typical for a particular age - Developmental psychopathology – focuses on disorders of childhood within the context of life-span development, enabling us to identify behaviors that are considered appropriate at one stage but disturbed at another - DSM-IV-TR o Childhood disorders were in 1 chapter - DSM-5 o Childhood disorders were in 2 chapters:  Neurodevelopmental Disorders  Disruptive, Impulse-control and conduct disorders o New names for disorders  Mental retardation  intellectual disability (AAIDD) o Autism Spectrum disorder  Asperger’s disorder  Disintegrative disorder  Pervasive developmental disorder o Specific learning disorder  Dyslexia  Dyscalculia - Prevalent childhood disorders are divided into: o Externalizing disorder - characterized by more outwarddirected behaviors  Aggressiveness, noncompliance, overactivity, and impulsiveness  Includes attention-deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder o Internalizing Disorders - characterized by more inwardfocused experiences and behaviors 1

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Depression, social withdrawal, and anxiety Category includes childhood anxiety and mood disorders o Children and adolescents may exhibit symptoms from both domains - Behaviors that comprise externalizing and internalizing disorders are prevalent across many countries o Externalizing behaviors are consistently found more often among boys o Internalizing behaviors more often among girls, at least in adolescence - Childhood disorders involve an interaction of genetic, neurobiological, and psychological factors o Another disorder that adversely impacts children: asthma 13.1.1 Asthma - Disorder of the respiratory system - Prevalence rates of asthma are highest for children ages 5-14 and 15-19 - Childhood: more common in boys - Adulthood: more common in women - Exercise-induced asthma - Negative emotions can induce asthma 13.2 Attention-Deficit/Hyperactivity Disorder - Hyperactive – constantly in motion o Difficulty concentrating - Attention-deficit/Hyperactivity Disorder (ADHD) o When hyperactivity is severe o National ADHD Awareness Day in the US  Started on September 7, 2004 Clinical Descriptions, Prevalence and Prognosis of ADHD - “vicious cycles” with these three domains o poor social skills o aggressive behavior o overestimation of one’s social abilities - DSM-5 includes three specifiers to indicate which symptoms predominate:

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Predominantly inattentive: children whose problems are primarily those of poor attention o Predominantly hyperactive-impulsive: children whose difficulties result primarily from hyperactive/impulsive behavior o Combined: children who have both sets of problems Combined specifier is the most common Inattentive specifier is usually difficulty in focused attention and speed information o Perhaps caused by problems involving dopamine and prefrontal cortex Differential diagnosis is difficult between: ADHD and Conduct Disorder o Frequently co-occur o ADHD is associated more with off-task behavior in school, cognitive and achievement deficits, and a better longterm prognosis  Children with ADHD act out less in school and elsewhere and are less likely to be aggressive and to have antisocial parents  Their home life is also usually marked by less family hostility, and they are at less risk for delinquency and substance abuse in adolescence compared to children with conduct disorder o When a child has both disorder, the worst features of each manifest Internalizing disorders co-occur with ADHD o 30 % of the children with ADHD have internalizing disorder o 15 to 30 % of children with ADHD have learning disorder Having both ADHD and conduct disorder is associated with substance use disorder Prevalence is about 3 to 7 % worldwide ADHD is more common in boys than in girls o Depends on whether it is clinical referrals or general population o

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Although some children show reduced severity of symptoms in adolescence, 65 to 80 % of children with ADHD still meet criteria for the disorder in adolescence o 15 % of people continued to meet DSM criteria as 25year-old adults o Close to 60 % continued to meet DSM criteria for ADHD in partial remission as adults o Thus, ADHD symptoms may decline with age, but they do not entirely go away for many people Etiology of ADHD Genetic Factors - 70 to 80 % heritability rates - Role of the neurotransmitter dopamine o Dopamine receptor – DRD4  Association with ADHD is stronger in this gene o Dopamine transporter – DAT1  Association with ADHD is mixed o Not gene alone, needs to be activated in an environment - Gene-environment role should be look on Neurobiological Factors - Brain structure and function are different in children with and without ADHD o Areas in the dopaminergic areas of the brain o Less activation in the Pre-frontal cortex - Perinatal and Prenatal Factors o Low birth weight  But can be mitigated by maternal warmth o Tobacco and alcohol use - Environmental Toxins o Additives and artificial colors  Feingold diet  Not effective o Refined sugar o Lead o Nicotine  22 % of mothers of children with ADHD reported smoking during pregnancy

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May affect the dopaminergic areas of the child’s brain

Psychological Factors - Interaction of these factor with the neurobiological factors - Family structures Treatment of ADHD - Typically treated w/ medications and behavioral therapies based on operant conditioning Stimulant Medications - Methylphenidate or Ritalin have been prescribed since 1960 - Food and Drug Administration-Approved medications: o Adderall o Concerta o Strattera - Used to reduce disruptive behavior and improve ability to concentrate o Improved 75 % of people with ADHD - Multimodal Treatment of Children with ADHD (MTA) study o (1) medication alone o (2) medication plus intensive behavioral treatment, involving both parents and teachers o (3) intensive behavioral treatment alone o Children receiving medication alone had fewer ADHD symptoms than children receiving intensive behavioral treatment alone o The combined treatment was slightly superior to the medication alone and had the advantage of not requiring as high a dosage of Ritalin to reduce ADHD symptoms o The combined treatment yielded improved functioning in areas such as social skills more than did the medication alone o The medication alone and the combined treatment were superior to community-based care, though the behavioral treatment alone was not o Effects did no persist beyond the study  Psychological Treatment 3

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Parent training and changes in classroom management The focus of these programs is on improving academic work, completing household tasks, or learning specific social skills, rather than on reducing signs of hyperactivity Intensive behavioral therapy may be as effective as Ritalin combined with a less intensive behavioral therapy

13.3 Conduct Disorder - Another externalizing disorder - Focus on behaviors that violate the basic rights of others and violate major societal norms o Illegal behaviors - Frequent and severe than any other common pranks and mischiefs among children and adolescents - Common: cruelty to animals, damaging property lying and stealing o Marked by callousness, viciousness and lack of remorse  DSM-5 labelled this specifier as limited prosocial emotions - Oppositional Defiant Disorder (ODD) o Related but less understood externalizing disorder o Diagnosed to children who has mild manifestation of conduct disorder o Comorbid with ADHD - 4 times more common in boys Clinical Descriptions, Prevalence and Prognosis of Conduct Disorder - Defined by the impact of the child’s behavior on people and surroundings - Pittsburgh Youth Study o Association of conduct disorder with substance use and delinquent acts - Anxiety and depression are comorbid among children with conduct disorder, 15 to 45 % - Prevalence rate of 9.5 % o 4 to 16 % among boys o 1.2 to 9% among girls - Life-course-persistent type – associated with an early age of onset and continued problems into adolescence and adulthood

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Adolescent-onset type - begins in the teenage years and is hypothesized to remit by adulthood, though a recent follow-up study has not supported the idea that this type remits Etiology of Conduct Disorder Genetic Factors - Heritability likely plays a part o Along with family-environment - Criminal and antisocial behavior – genetic and environmental factors o Similar for both boys and girls - 40 to 50 % of antisocial behaviors are heritable - Distinguishing heritable behaviors are important o Aggressive behavior – heritable o Delinquent acts – may not be heritable - Conduct disorder behaviors that begin in childhood are more heritable than those behaviors that begin in adolescence - Low MAOA gene and maltreatment in childhood predicts conduct disorder o Gene x Environment interaction is important Neuropsychological Factors and ANS - Poor verbal skills, difficulty w/ executive functioning and problems with memory - IQ of 1 S.D. below age-matched - ANS abnormalities are associated with conduct disorder o Low levels of skin conductance o Low heart rate o Both suggest low arousal level  Meaning lesser fear of being punished Psychological Factors - Growth of moral awareness o Acquisition of a sense of what is right and wrong and the ability, even desire, to abide by rules and norms o Children with conduct disorder seem to be deficient in this moral awareness  lacking remorse for their wrongdoing - Modeling and Operant Conditioning o Imitation of parents, reinforcement of it being “effective” 4

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Parenting characteristics Social-cognitive perspective on aggressive behavior o By Kenneth Dodge and associates (Dodge’s Theory of Aggression)  Viscous cycle o Social processing information and low arousal levels Peer Influences - Two broad areas: o Acceptance or rejection by peers  When paired with ADHD leads to conduct disorder o Affiliation with deviant peers  Environmental influence (i.e. neighborhood and family) play a role in associating with deviant peers Sociocultural Factors - Poverty and urban living = higher levels of delinquency - Early anti-social behaviors and SES disadvantage predicts criminal acts Treatment of Conduct Disorder - Most effective treatment is the one that addresses multiple system: family, peers, school and neighborhood Family Intervention - Intervening with the parents and families of the child makes an impact to lessening symptoms o Especially when early - Family Checkup Treatment (FCU) o 3 meetings to get to know, asses and provide feedback to parents - Parent Management Training (PMT) o By Gerald Patterson o Parents are taught to modify their responses to their children so that prosocial rather than antisocial behavior is consistently rewarded  Operant conditioning o More effective o Persist for 1 to 3 years

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Multisystemic Treatment (MST) - Intensive and comprehensive therapy services - Intensive, family-focused and community-based treatment program for chronically violent youth 13.4 Depression and Anxiety in Children and Adolescents - Internalizing disorders - Comorbid with ADHD and conduct disorder - Depression and anxiety among children is shown in the same way: o Children with depression show low levels of positive affect and high levels of negative affect o Children with anxiety show high levels of negative affect but do not show low levels of positive affect Depression Clinical Descriptions and Prevalence of Depression - Focus on childhood and adolescence - Children and adolescents ages 7 to 17 and adults both tend to show the following symptoms: o depressed mood o inability to experience pleasure o fatigue o concentration problems o suicidal ideation - More guilt for child and eating problems - Recurrent o 4 to 8 years - Prevalence: o 1 % in preschoolers o 2 to 3 % in school-age children o 6 % for girls and 4 % for boys in adolescence  Gender differences does not occur till 12 Etiology of Depression in Childhood and Adolescence - Genetic factor plays a role o 4 times risk for the child o Still via genes and environment - Early adversity and negative life events o Onset between ages 15 to 20 years old - Parental rejection 5

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Negative relationships Consistent with Beck’s Theory and the hopelessness theory of depression - Attributional style of Children o Stable to more global or internal as they get older o Stable style until adolescence o Not effective etiology until middle years of child Treatment of Childhood and Adolescent Depression - Use of antidepressants but with side effects o Diarrhea o Nausea o Sleep problems o Agitation - Treatment for Adolescents with Depression Study (TADS) o Prozac o CBT o Combined – most effective - Medications – effective in anxiety disorder; less effective for OCD and depression - 7 out of 439 adolescents attempted suicide o 1 CBT: 6 Prozac o Children taking medication were at most risk for suicidal ideation - 96 % recovery o Recurring episode for 5 years o More common recurring for girls o Kind of treatment does not matter - 65 % of adults treated with CBT improved o Most effective among Caucasian o Good coping skills o Recurrent depression - Preventive intervention for depression: o Selective prevention programs – target particular youth based on family risk factors (e.g., parents with depression), environmental factors (e.g., poverty), or personal factors (e.g., hopelessness)

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Universal programs – targeted toward large groups, typically in schools, and seek to provide education and information about depression Selective prevention program was more effective in treating depression than universal programs

Anxiety - Fears are often reported by girls than boys Clinical Descriptions and Prevalence of Anxiety - Impaired functioning for it to be considered as anxiety - Only 3 to 5 % diagnosis for children and adolescents - Separation Anxiety Disorder o Characterized by constant worry that some harm will befall their parents or themselves when they are away from their parents  First observed when children begin school o In DSM-5 this was moved to Anxiety Disorder  Also removed the onset prior to 18 years old - Social Anxiety Disorder (Social Phobia in DSM-IV-TR) o Extreme shyness  Selective mutism o 1 % prevalence o More common in adolescents - Children who experienced traumas are high risk for PTSD o Experienced as adults experience PTSD o Symptoms include:  Intrusions or reexperiencing the traumatic event trauma-related situations or  Avoiding information  Negative changes in cognitions or mood related to the traumatic event  Hyperarousal and hypervigilance - Obsessive compulsive disorder is also found among children and adolescents o Prevalence estimates ranging from less than 1 to 4 % o The symptoms in childhood are similar to symptoms in adulthood: both obsessions and compulsions are involved 6

The most common obsessions in childhood involve dirt or contamination as well as aggression; recurrent thoughts about sex or religion become more common in adolescence o OCD in children is more common in boys than girls  but this sex difference does not remain in adolescence or adulthood Etiology of Anxiety Disorders - Genetics play role o 29 to 50 % heritability o Of course, gene-environment again - Parental control and overprotectiveness o Rather than parental rejection (in depression) is associated with anxiety - Emotion-regulation and insecure attachment - Theories about the causes of anxiety disorders in children are similar to theories about their causes in adulthood Treatment of Anxiety Disorders - Major focus is exposure to the feared object - CBT can be helpful to children with anxiety disorders o Beyond exposure, psychoeducation, cognitive restructuring, modelling, skills training and relapse prevention - Coping Cat – used with children between the ages of 7 and 13 o It focuses on confronting fears, developing new ways to think about fears, exposure to feared situations, practice, and relapse prevention - Philip Kendall and colleagues conducted a randomized controlled trial comparing individual CBT, family CBT, and family psychoeducation o Both individual and family CBT included the Coping Cat workbook, both were more effective than family psychoeducation at reducing anxiety Effects lasted 1 year after treatment  o The family CBT was more effective than individual CBT when both parents had an anxiety disorder o

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Levels of parental anxiety when deciding on a treatment should be considered o Another study examined the Coping Cat treatment alone and in combination with sertraline (Zolof) for children found that the combination treatment was more effective than either the Coping Cat or medication alone  Combination treatment works well for children with more severe anxiety - Behavior therapy and group cognitive behavior therapy have been found to be effective for social anxiety disorder in children - Two recent reviews suggest that CBT is an effective treatment for children and adolescents o CBT appears to be equally as effective as medication, and CBT plus medication is more effective than medication alone but not more than CBT alone 13.5 Learning Disabilities - Condition in which a person shows a problem in a specific area of academic, language and speech or motor skills that is not due to intellectual disability or deficient education opportunities Clinical Descriptions - Term learning disabilities is not use in the DSM-5 but is used to group 3 categories of disorders: o Specific Learning Disorder o Communication Disorder o Motor Disorder - Grouped in the neurodevelopmental disorders chapters - Often identified and treated within school system rather than through mental health clinics - Slightly more common in boys o Specific learning disorder involving reading is far more common in boys than in girls - Prevalence rates for specific learning disorders involving reading or math is 4 to 7 % in children

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Etiology of Learning Disabilities - Dyslexia – most prevalent of this group of disorders o 5 to 10 % of school-age children experienced this - In the DSM-5, dyslexia and dyscalculia are coded as specifiers for the category of specific learning disorder Etiology of Dyslexia - Family and twin studies confirm that there is a heritable component o Same genes associated with typical reading abilities  Generalist genes - Gene-environment interactions: varies depending on parental education o Gene plays a bigger role in dyslexia among children whose parents have more education - Core deficits in dyslexia include problems in language processing o Many of these processes fall under phonological awareness which is believed to be critical to the development of reading skills - fMRI studies showed that children with dyslexia failed to activate the temporoparietal area during phonological processing tasks

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Showed less activation in the left temporoparietal and occipitotemporal areas - fMRI studies among adults investigated 3 types of readers: o PPR (persistently poor readers) – trouble reading in early and latter part of the school  Performed poorly in behavioral reading tasks  Activated the traditional area but also area of the brain associate to memory o AI (Accuracy Improved) – trouble reading early in school but not latter in school  On my tasks, performed as well as NI  Did not showed as much activation in traditional areas but showed activation in the right side o NI (nonimpaired readers) – no trouble reading  Activated traditional areas of the brain linked to reading - Limited to ...