PSYC 360 Final

What are the three limitations of the DSM 5 in the diagnosis of childhood disorders?

1. Issues differ in relevance at different stages of development. There are salient tasks at each stage of development, i.e. the things that challenge you at each stage of development differ.

2. Behaviors that are normative or adaptive change over the course of development.

3. The symptoms associated with a disorder may change over the course of development.

The occurrence of what in development can cause pathology?

The failure to accomplish salient developmental tasks at each stage of development can cause pathology.

Is the concept of salient developmental task in the DSM 5?

But the concept of a salient developmental task is not in the DSM 5.

Why is it problematic that the DSM 5 just has a list of symptoms that applies to all age groups? Give an example.

The DSM 5 just has a list of symptoms that applies to all age groups, but that's problematic because some symptoms are normative at some ages and pathological at others. It's not concerning if a six year-old wants to spend a lot of time with their parents, but it's concerning if a fifteen year-old does.

The DSM 5 doesn't account well for what? Give an example.

The DSM 5 doesn't account well for the reality that the symptoms of a pathology change across the lifespan. For example, depression presents differently at different ages.

Does the DSM 5 work well for children?

The DSM 5 does not work well for children.

How were childhood disorders groups in the DSM IV? How are they grouped in the DSM 5?

In the DSM IV, childhood disorders were grouped according to the similarity of the symptoms, whereas childhood disorders in the DSM 5 are grouped according to etiology.

In the DSM 5, disorders that are presumed to reflect problems in CNS development (e.g., autism, intellectual disabilities, ADHD) are called what?

In DSM 5, disorders that are presumed to reflect problems in CNS development (e.g., autism, intellectual disabilities, ADHD) are called "Neurodevelopmental disorders."

In the DSM 5, aggression or defiant behaviors are now in what category? (Hint: "blank and blank blank disorders")

In the DSM 5, aggression or defiant behaviors are now in the "disruptive and impulse control disorders."

How does the classification of ADHD and conduct disorders in the DSM IV compare to that of the DSM 5?

ADHD and conduct disorders were in the same category in DSM IV, but are now in different categories in DSM 5.

Why do children often go to the clinic? Why do adults often go to the clinic?

Children often go to the clinic because they're distressing someone else, whereas adults often go to the clinic because they are distressed. The kids are there because they're misbehaving.

What are the two major classes of symptoms in Attention Deficit Hyperactivity Disorder?

Hyperactivity/impulsiveness and attention deficits.

Why doesn't the term ADD exist in the DSM?

The term ADD doesn't exist in the DSM - it was created by the media.

What symptoms will hyperactive kids present with?

Hyperactive students will be fidgety, always physically active. They have difficulty sitting still, can't stay focused on boring activities, talk excessively, blurt out answers in class.

Explain Russell Barkley's theory of a pre-potent response and how it relates to hyperactive children.

Russell Barkley's theory of a pre-potent response: short-term distractions have immediate reinforcement and hyperactive children cannot resist these distractions.

What are the attention deficits in ADHD?

Attention deficits in ADHD: difficulty sustaining attention, easily distracted, forgetful.

What is the paradox of ADHD?

The paradox of ADHD: the person has attention problems when they're not presented with new information. They always need new information.

Kids with ADHD don't necessarily have difficult with what, but they are easily "blanked."

Kids with ADHD don't necessarily have difficulty paying attention to things, but they are easily distracted.

Explain what is meant by the statement "kids with ADHD always have correlated problems."

Kids with ADHD always have correlated problems: they're rarely well liked (i.e., they experience peer rejection), have academic difficulties and learning disorders.

Emotion regulation is the ability to do what?

Emotion regulation is the ability to modify one's emotions to fit the situation.

Kids with ADHD act on their "blanks."

Kids with ADHD act on their emotions.

ADHD has a very high comorbidity with what?

ADHD has a very high comorbidity with Conduct Disorder.

Are developmental changes in ADHD well understood?

Developmental changes in ADHD are not well understood. We don't know what happens to adults with ADHD.

What two phenomena suggest that the ADHD category is too wide?

There are many different reasons why a kid might exhibit ADHD symptoms (e.g., anxiety, impulsivity) and there are many different effective treatments, so some people question whether or not the category is meaningful. The category might be too wide.

What are the three subtypes of ADHD?

There are three subtypes of ADHD: ADHD Hyperactivity/Impulsivity (H/I), ADHD with Attention Deficits (AD) and combined.

Barkley argues that ADHD is about what? Not about what?

Barkley argues that ADHD is about freedom from distractibility, not about attention deficits. He therefore wants to rename the disorder.

Some people argue that there should be an attention disorder for what type and another for what type?

Some argue that there should be an attention disorder for the sluggish and daydream types and another disorder for the distractible types.

What are four theories about the outcomes of adult ADHD?

Some will develop coping mechanisms and be functional adults.

Some will cope by abusing alcohol.

Some will choose professions that reduce the negative consequences of the symptoms.

Some may actually get better.

For what two reasons might adults get labeled with ADD instead of ADHD?

Adults get labeled with ADD instead of ADHD perhaps because ADD is a less stigmatizing label and because there aren't good behavior descriptors to describe adult hyperactivity.

What does Schwartz believe about attention problems, hyperactivity and impulsiveness in adults?

Schwartz believes that few adults have attention problems and that there are more adults with hyperactivity and impulsiveness problems. Schwartz believes that ADD is a media-created myth - it's actually a problem with distractibility, not with attention deficits.

What is the gender difference in ADHD?

Boys are three times more likely to have ADHD than are girls.

ADHD drugs are what type of drug?

ADHD drugs are stimulants in the same class of drugs as methamphetamine.

Why do ADHD medications allow the kids to focus better?

ADHD drugs increase internal stimulation, which allows the kids to focus better.

You want to give a kid with ADHD medication in conjunction with what?

You want to give a kid medication in conjunction with behavior therapy.

Why are adults with ADHD much harder to medicate than are children?

Adults with ADHD are much harder to medicate than are children because Ritalin is much more addicting for adults than it is for children.

Conduct disorder is very comorbid with what?

Conduct disorder is very comorbid with ADHD.

Conduct disorder is the term that most people think about when they think about what?

Conduct disorder is the term that most people think about when they think about juvenile delinquency.

What are the two key features of conduct disorder?

Key features of conduct disorder are lack of remorse or guilt. They don't think they're at fault for the bad things they did.

What are the three traits of kids with conduct disorder? What are examples of things that they do?

Kids with conduct disorder engage in aggressive behavior toward animals or people, rule breaking or violations of laws, destruction of property, and stealing/deception. They're deceitful, aggressive and defiant.

Are boys or girls more likely to have conduct disorder?

Boys are more likely to have conduct disorder.

How do kids with conduct disorders do at school? What are their relationships like with their peers?

Kids with conduct disorders are rejected by peers and are failing at school, which can cause depression and low self-esteem.

Kids with conduct disorder are likely to experience peer rejection and poor school performance. These two things can cause what two things?

Kids with conduct disorders are rejected by peers and are failing at school, which can cause depression and low self-esteem.

What are the two subtypes of kids with conduct disorder?

Life-Course Persistent/Early Starters and Adolescent-Limited/Late Starters.

Explain the Life-Course Persistent/Early Starter subtype. What are the two underlying causes? How do they develop in school and with their peers?

They're almost always boys. They come into the world with a biological disadvantage (e.g., irritability, impulsivity) and the mom and dad respond to the kid maladaptively.

They struggle socially in school because they're so aggressive, which leads to peer rejection and poor academic performance. His peer group in middle school is going to be other antisocial kids, who reinforce his behavior.

Explain the Adolescence-Limited/Late Starter subtype. How does their behavior differ from early starters'?

These kinds of kids are doing okay through most of development, but they have a two or three year period of antisocial behavior, which tends to manifest itself as property crimes or status offences. They tend to not commit aggressive behaviors, unlike the early starters. The antisocial behavior disappears after adolescence.

What is the DSM 5's new subcategory for conduct disorder?

The DSM 5 has a new subcategory for conduct disorder called limited prosocial emotions.

What does the subcategory limited prosocial emotions mean?

Limited prosocial emotions means that the person lacks empathy. Conduct disorder is presumed to be the precursor to antisocial personality disorder.

Is there heterogeneity in conduct disorder?

There is heterogeneity in conduct disorder, i.e. there are subtypes.

What is the category for angry, defiant kids?

Oppositional defiant disorder (ODD) is the category for angry, defiant kids.

What characterizes the behavior of kids with ODD?

They are have temper tantrums, are hard to manage.

When does ODD tend to be diagnosed?

It tends to be diagnosed earlier than conduct disorder. ODD is often diagnosed before kids start school.

Why might the ODD label be too broad and overused?

However, defiant behavior is normal for kids, so some degree of oppositionality is normal. The ODD label has perhaps gotten too broad, it is overused .

Many clinicians view ODD as the precursor to what?

Many clinicians view ODD as the precursor to conduct disorder.

Are boys or girls more likely to have conduct disorder, ADHD and ODD?

Boys are more likely to have conduct disorder, ADHD and ODD than are girls.

What is one reason why boys are diagnosed more often with conduct disorder, ADHD and ODD than are girls?

A reason why boys are diagnosed more often with the above disorders: girls engage in relational and indirect aggression than do boys, whereas boys engage in more physical aggression.

Impulsivity and ADHD are often thought to have what causes?

Impulsivity and ADHD are often thought to have genetic causes.

For ADHD, conduct disorder and ODD, "blank" is the rule.

For ADHD, conduct disorder and ODD, equifinality is the rule. There may be many paths to developing these disorders.

Barkley contends that ADHD is what type of problem?

Barkley contends that ADHD is a genetic problem.

Barkley contends that kids with ADHD are born with what?

Barkley contends that kids with ADHD are born with hypofrontality.

What neurotransmitter is implicated in impulsive behavior?

Serotonin is implicated in impulsive behavior.

What physiological measurement is an indicator of aggression and conduct disorder?

Low resting heart rate is an indicator of aggression and conduct disorder. They're relatively fearless.

What did Ken Dodge create?

Ken Dodge created the influential computer model of the mind that underlies the intervention programs in schools nationally.

What is the first step of Dodge's model?

Encoding

What occurs in the encoding step? What is notable about the encoding of aggressive kids?

Step 1: Encoding is transforming everything from the outside world and moving it inside. Aggressive kids encode less information.

What is the second step of Dodge's model?

Interpretation of social cues.

What occurs in the interpretation of social cues?

Step 2: Interpretation of social cues, which is when the child tries to interpret an event.

What is the third step of Dodge's model?

Response access.

What occurs in response access?

Step 3: Response Access, which is when the child chooses a response. Aggressive kids often choose violent responses.

What is the fourth step of Dodge's model?

Response evaluation/decision.

What occurs in the response evaluation/decision? What is typical of aggressive kids in this step?

Step 4: Response evaluation/decision, which is when the child evaluates the selected response (e.g., "Will the behavior work? Can I do it successfully?). Aggressive kids think aggressive behavior works, is successful.

What is the fifth step of Dodge's model?

Enactment.

What occurs in enactment?

Step 5: Enactment, which is when the child performs the behavior.

What does Dodge contend is a contributing factor in the development of violent and aggressive cognitions?

Dodge contends that being in aggressive or violent homes leads to the development of violent and aggressive cognitions.

What is inconsistent parenting? Give an example.

Inconsistent parenting is when the parent punishes or responds to the child maladaptively sometimes. For example, a parent gives their kid candy after the kid throws a temper tantrum because the parent wasn't giving them candy when the kid asked for it the first time.

Inconsistent parenting tends to reward what two things?

Inconsistent parenting tends to reward temper tantrums and other high-amplitude behaviors.

Parents who are "blanking," lack "blank," are "blank," or expose their kids to "blank blank" are strongly correlated with conduct disorder.

Parents who are rejecting, lack warmth, are hostile, or expose their kids to marital violence are strongly correlated with conduct disorder. There is equifinality with conduct disorder.

Why is inconsistent parenting so problematic?

Inconsistent reinforcement schedule is very hard to unlearn and extinguish, which is why inconsistent parenting is so problematic. It explains why gambling can be so addicting.

What parental behavior is a strong predictor of aggression?

Harsh, punitive parental discipline is a strong predictor of aggression.

What is enuresis?

Enuresis is bedwetting.

What are the four subtypes of enuresis?

Nocturnal versus diurnal and primary versus secondary.

What characterizes diurnal kids?

Diurnal kids have bladder problems throughout the day and night.

What characterizes nocturnal kids?

Nocturnal kids only have problems at night.

What characterizes primary kids?

The primary kid has never established bladder control at night.

What type of condition is primary enuresis?

Primary enuresis is a genetic condition and is not associated with any form of psychological stress.

What causes primary enuresis to end?

It'll end on its own and will not be affected by interventions.

What characterizes a secondary kid?

The secondary kid has bladder control problems after a period of being dry. They might start wetting the bed at age seven after two years of being dry.

Secondary enuresis is associated with what and is often a sign of what?

Secondary enuresis is associated with psychopathology and is often a sign of stress exposure.

What are the two treatments for secondary enuresis?

Two treatments for secondary enuresis: tricyclic antidepressants and the Bell and Pad. Note: Nobody understands why tricyclics works.

What is the Bell and Pad? How does it work?

The Bell and Pad is an alarm that rings when the kid wets the bed, which alerts them to when they get wet. You positively reinforce when they don't wet the bed.

How effective is the Bell and Pad for treating secondary enuresis? What is its major downside?

The Bell and Pad is quite effective for treating secondary enuresis, though it is a treatment that requires a lot of commitment.

Why can't enuresis be diagnosed before age five?

Enuresis can't be diagnosed before age five because it's normal for younger kids to wet the bed.

The new terminology in DSM 5 refers to mental retardation as what?

The new terminology in DSM 5 refers to mental retardation as "intellectual disabilities." The term mental retardation became stigmatizing and was therefore dropped.

An IQ of what or below meets criteria for ID? What is also important?

An IQ of 70 or below meets criteria for intellectual disability, but clinical judgment is important.

Another criterion for ID is impairment in what?

Another criteria for intellectual disability is impairment in general living skills. Kids with intellectual disabilities will be delayed in this area.