Exam 3

Unit 3 Flashcards

COMMUNICATION DISORDERS

COMMUNICATION DISORDERS

What is involved in effective communication?

Effective communication involves:

1. Clear expression of thoughts

2. Active listening

3. Both speaker and listener understanding the message of the conversation

4. Signaling to appropriate Nonverbal Cues (body language)

5. Give feedback to ensure comprehension

Communication

Any verbal/nonverbal behavior that influences the behaviors, ideas or attitudes of another individuals.

It is the process of sharing information between people, groups or places. It requires a Sender, Receiver, and a Message.

Speech vs Language

Speech is the PHYSICAL ACT of producing sounds, including an individual’s articulation, fluency, voice, and resonance. Speech is considered “expressive” production of sounds

Language, regards the socially-shared rules about word meaning

Communication Disorders

A disorder characterized by deficits in speech, language, and/or communication

Impairments can occur in ability to receive, send, process and comprehend verbal/nonverbal messages

The 4 common types of communication disorders

1. Language Disorder

2. Speech-Sound Disorder

3. Child-Onset Fluency Disorder

4. Social Communication Disorder

Language Disorder - Definition

Problems acquiring, comprehending and using language (written OR spoken)

These language difficulties cannot be explained by other conditions, such as hearing loss or autism, and cannot be “enhanced” by exposure to language (even during early development).

Receptive vs Expressive Language Disorders

RECEPTIVE Language disorders involve difficulty in understanding written/spoken language

EXPRESSIVE language disorders involve problems with communicating thoughts and feelings through language

Language Disorder - Diagnostic Criteria

1. Language skills are much lower, perceptually and quantifiably, than expected for the person’s age. Results in limitations in effective communication, social participation, academic achievement or occupational performance.

2. Persistent difficulties in acquiring/using language to communicate.

3. Onset of symptoms is in early developmental period (birth-5yo)

4. Difficulties are NOT ATTRIBUTABLE to other sensory impairments OR medical conditions.

Language Disorders - Physical Characteristics

1. Reduced Vocabulary (word knowledge + use)

2. Limited sentence structure (deficits in use of syntax/morphology)

3. Impairments in discourse (inability to use vocab + connect sentences to explain a topic).

Language Disorder - Prevalence + Risk Factors

Prevalence - 7% of school-aged children (50% outgrow these issues).

Risk Factors -

1. Genetics - family history of language/communication issues can INCREASE likelihood of developing disorder

2. Chronic Ear Infections - Repeated ear infections during early childhood can impact hearing, which may affect language development

3. Temporal Lobe Processing/functional connectivity deficits - problems in the temporal lobe (Wernicke’s = language comprehension) may contribute to language difficulties

Between receptive and expressive language problems, which is more resistant to treatment?

Receptive Language problem are the most resistant to treatment.

Understanding language (receptive) is a COMPLEX process that involves not only hearing words but interpreting their meanings, whereas producing spoken language (expressive) can be readily practiced.

Speech Sound Disorder - Definition

Problems producing speech sounds.

Most common sound mix-ups are of w/r sounds.

Speech Sound Disorder - Characteristics

1. Impairment typically arises in articulation/sound production errors rather than word knowledge (which is a language disorder)

2. Trouble controlling rate of speech

3. Compared to peers in the same developmental age, speech of child tends to miss articulatory targets (most prominent in complex sounds)

Speech Sound Disorder - Prevalence + Risk Factors

Prevalence - 2-25% for children aged 5-7 yo

Risk Factors -

1. causes are unknown

2. Correlated risk factors include:

   1. Family history

   2. lack of learning supports

   3. oral sucking habits

   4. ear/nose/throat problem

Childhood-Onset Fluency Disorder - Definition

Problems with time-patterning of speech. Usually shown via repeated + prolonged pronunciation of certain syllables that interfere with communication

Most commonly associated with stuttering

Stuttering

A type of speech disorder that causes interruptions in the flow of speech.

• It can be mild-to-severe

• Intra-speaker variation across speaking situations and over time.

Childhood-Onset Fluency Disorder - Diagnostic Criteria

1. Disturbance in normal fluency and time of patterning of speech that are inappropriate for child’s age/language skills + persist over time and marked in:

   1. Sound/syllable repetitions

   2. sound prolongations of consonants

   3. broken words (e.g. pauses within a word)

   4. etc…

2. Disturbance causes anxiety about speaking + limitations in effective speech

3. Onset of symptoms occurs in early developmental period

4. Disturbance NOT ATTRIBUTABLE to speech-motor or sensory deficit

Childhood-Onset Fluency Disorder - Prevalence + Risk Factors

Prevalence -

• 80% of children who stutter < 5yo stop after 1 year of schooling

• 1% of people have COFD and prevalence peaks at 5 yo

Risk Factors -

1. Genetics

2. Environmental Factors (less of a cause)

Social Pragmatic Communication Disorder - Definition

Problems with the social use of language and communication.

Difficulties involve both expressive/receptive skills -

1. being able to adapt one’s communication to social context (receptive)

2. being able to understand the nuances and meanings expressed by others (expressive)

Social Pragmatic Communication Disorder - Diagnostic Criteria

Persistent Difficulties across four areas:

1. Deficits in using communication for social purposes (e.g. greeting/sharing information appropriately)

2. Difficulties following rules of language, such as conversation-taking

3. Difficulties in understand what someone is not explicitly saying (making inferences) and making out meaning during ambiguous speech (e.g., thinking “break a leg” actually means to break your leg during your audition)

What is Pragmatics in Language?

The use of language in context, and the context-dependence of various aspects of interpreting speech.

Social Pragmatic Communication Disorder - Prevalence + Risk Factors

Prevalence -

• Onset = diagnoses occurs AFTER 4-5 YO. More subtle forms diagnosed in adolescence (10+)

• Can have lasting negative impact on interpersonal relationships, behaviors and related skills

Risk Factors -

1. Family history of ASD/Communication Disorder/Specific Learning Disability

2. Prenatal medication exposure (questionable)

How are Communication Disorders different from the following disorders: ASD, ID, LD, and Selective Mutism

While communication deficits are present in ASD, ID, LG and SM, each has a distinct characteristic(s) that set them apart from Comm. Disorders.

1. ASD includes challenges in social interactions and repetitive behaviors.

2. ID affects communication proportionally to other effected cognitive/developmental pathways.

3. LD, such as dyslexia, impact academic skills which can include language processing, but this effect is broad.

4. SM involved anxiety-related inability to speak in certain social contexts, despite normal language abilities in comfortable environments.

Comm. Disorders overall relate to language deficits and challenges are primarily marked by language challenges (instead of broadly)

Name the communication disorder: Allison has difficulty understanding directions, struggles to express her thoughts, and uses short, disjointed sentences.

LANGUAGE DISORDER

trouble understanding directions + difficulty expressing thoughts (disorganized speech) are characteristics of Language disorders

Name the communication disorder: Josh struggles with writing, understanding humor or satire, topic shifting, and maintaining appropriate volume in class.

SOCIAL PRAGMATIC COMMUNICATION DISORDER

Difficulties understanding humor/satire, changing topics randomly and not managing volume aligns with SPCD

Name the communication disorder: Max is difficult to understand due to sound substitution and mispronunciations like “miwk” for milk.

SPEECH SOUND DISORDER

Challenges with sound substitution + mispronunciations (“milk” → /miwk/) point to SSD. This disorder involves problems with articulation or phonological processes

Name the communication disorder: Lydia avoids reading aloud due to stilted speech and has experienced teasing about stuttering.

CHILDHOOD-ONSET FLUENCY DISORDER (stuttering)

Stilted speech (disruption in speech flow) + avoidance of reading aloud (anxiety) point to COFD

Treatment for Communication Disorders

Response-Contingency Therapy - technique that involves providing different responses based on whether the person responds in a fluent way or not.

1. If the child responds FLUENTLY, they are given positive reinforcement (toys, more game time, etc.)

2. If the child responds NON-FLUENTLY, give corrected feedback

Attention Deficit Hyperactivity Disorder (ADHD)

Neurodevelopmental Disorder that causes difference in brain that effects:

1. Attention (inattention)

2. Behavior

   1. Activity Levels (hyperactivity)

   2. Cognitive Control (impulsivity)

Attention Deficiency Hyperactivity Disorder (ADHD) - Diagnostic Criteria

1. Persistent pattern of inattention that impedes on daily function. Criteria includes (6+ present for 6+ months):

   1. Makes careless mistakes

   2. Difficulty sustaining attention

   3. Easily distracted

   4. Often loses things

   5. Often forgetful

   6. Avoids/dislikes activities requiring sustained mental effort

   7. Fails to follow through on instructions

   8. does not listen even when being directly spoken to

2. Persistent Pattern of hyperactivity-impulsivity that impedes on daily function. Criteria includes (6+ behaviors for 6+ months):

   1. Hyperactivity

      1. Fidgets/squirms in seat

      2. leaves seat where staying seated is expected

      3. runs around/climbs excessively

      4. has difficulty playing quietly

      5. Talks excessively

   2. Impulsivity

      1. Blurts out answers before questions have been completed

      2. Has difficulty awaiting turn

      3. Interrupts Others

3. These impairments occur in two+ settings (e.g., school, extracurriculars, home, etc.)

4. Clear clinical evidence of significant impairment in functioning

5. Symptoms present before 12 YO

Attention Deficit/Hyperactivity Disorder - Subtypes of ADHD (“specifiers”)

1. Combined (ADHD-C) - has at least 6 inattentive + hyperactive/impulsive symptoms

2. Predominantly inattentive type (ADHD-PI) - 6 inattentive symptoms, but NOT 6 hyperactive/impulsive symptoms

3. Predominantly Hyperactive-impulsive type (ADHD-HI) - 6 hyperactive/impulsive symptoms, but NOT 6 inattentive symptoms

Executive Functioning

Cognitive processes in the brain that activate, integrate, and manage other brain functions (THINK: air-traffic control)

EF underlies a child’s ability for self-regulation functions (e.g., self-awareness, planning, monitoring, self-evaluation)

The 4 types of Executive Functions (used together in everyday life!)

1. Language processes - verbal fluency + use of self-directed speech

2. Cognitive processes - working memory (holds facts + mental manipulation), mental computation, planning, anticipation

3. Motor Processes - allocation of effort, following instruction

4. Emotional process - self-regulation + tolerating frustration

Executive Function (impairment) and Attention Deficit/Hyperactive disorder

What’s impaired | Results of Impairment:

1. Organize, prioritize, activate

   • trouble getting started

   • difficulty organizing work

   • misunderstand directions

2. Focus, shift + sustain attention

   • lose focus when trying to listen; forget what has been read

   • easily distracted

3. Regulate alertness, effort + processing speed

   • excessive daytime drowsiness

   • difficulty completing a task on time

   • slow processing speed

4. Manage frustration + modulate emotion

   • very easily irritated

   • feeling hurt easily

5. WM + accessing recall

   • forget to do planned task

   • difficulty following sequential directions

6. Monitor/regulate action

   • Find it hard to sit still/quiet

   • rush things/blurts out loud

Attention Deficiency/Hyperactive Disorder (ADHD) - Causes

1. Genetics - Dopamine D4 + D5 receptor genes; these receptors are distributed in cortical + limbic brain regions = ADHD seems to be related to disruption in dopamine signaling pathways

2. Perinatal Complications (questionable; might also predict comorbid aggression)

3. Parental Control (NO)

Attention Deficit/Hyperactive Disorder - Prevalence + Risk Factors

Prevalence -

• 11.4% (7M) US children 3-17 YO diagnosed with ADHD

• Those diagnosed MORE likely to have combined/HI subtypes

Risk Factors -

1. Genetics - Dopamine D4 + D5 receptor genes; these receptors are distributed in cortical + limbic brain regions = ADHD seems to be related to disruption in dopamine signaling pathways

2. Perinatal Complications (questionable; might also predict comorbid aggression)

3. Parental Control (NO)

4. Sugar (NO)

Attention Deficit/Hyperactivity Disorder - Developmental Pathway

1. Infancy

   • high activity level

   • unpredictable

   • inconsolable (difficult “temperament”)

2. Toddler (1-3 YO)

   • “normal” toddlers may appear “hyper”

   • ADHD toddlers have frenzied quality to their movements

   • Randomly going from one activity to another

   • temper tantrums

3. Pre-school (3-5 YO)

   • restless

   • careless

   • demanding

   • defiant

4. Middle childhood (treatment implemented)

   • In-Classroom; ADHD symptoms visible

   • comorbid ODD/CD

5. Adolescence

   • continuance of childhood symptoms (70%)

   • hyperactive/impulsive symptoms may decline

   • school dropout/parent conflict begins

6. Adulthood

   • Higher risk for crime

   • substance abuse (if ADHD comorbid with CD)

Attention Deficient/Hyperactive Disorder - How to Diagnose

1. Observation (i.e., classroom, home, clinic)

   • measures hyperactivity (more likely in younger kids in structured situations)

2. Behavior Rating Scales (e.g., Child Behavior Checklist; CBCL)

   • completed by parents/teachers

   • if disagreements occur, you want to assess if informants have different interpretations of behaviors

3. Neuropsychological Evaluation - typically used to assess:

   • Attention - e.g., continuous performance task (CPT), Auditory attention Task

   • Impulsivity - e.g., Timed Draw a Circle Task

   • Hyperactivity - e.g., Observation of Behavior During Tasks

4. Assess Comorbid Disorders - symptoms of ADHD must present on their own and NOT PART of other conditions (e.g., schizophrenia; psychotic disorder; mental disorders

Treatment for ADHD (2 types)

1. Behavioral Treatments

   • Parent Training

   • Classroom Accommodations

   • Individual Therapy

2. Medication

   • Stimulants

   • Non-stimulants

Parent Training - Structure

Teaches parents how to manage their child’s behavior using positive reinforcement, structure and clear expectations:

• Set consistent house rules/routine

• Don’t say you’re going to do something unless you follow through (kids remember lies!)

• Do homework at same time/place (stimulus control)

• Use daily charts + point systems for both rewards/consequences

• Use “when-then” directions (e.g., “when you do XXX, then you will get XXX”)

Parent Training - When to Reward Praise

1. Ignore DISRUPTIVE Behaviors

   • Attention to behavior is, in it of itself, reinforcement. Weaken response by ignoring (no reinforcement)

   • When behavior can’t be ignored, use PROPER “time-outs” (consequence)

2. Praise GOOD Behavior

   • Includes ALL improvements (no matter how small)

   • Use SUCCESSIVE APPROXIMATIONS (rewarding behavior that approximates desired behavior)

   • Praise incompatible behavior (“positive opposite”)

   • Use of behavior charts to make praise more salient

Behavior Chart (choosing a set of desired behaviors and rewarding stickers on days’ behavior is imitated)

Classroom Accommodations - How it Works

1. Seat child away from window/doors; sit within rows

2. Give instructions one at a time and repeat (when neccesary)

3. Allow students to have most challenging classes earlier in the day

4. Create worksheets/tests with fewer items (frequent quizzes rather than long tests)

5. Use of Daily Report Card/ Tracking System for Assignments

Individual Therapy - How it Works

1. Teach SOCIAL SKILLS

2. Help child solve social problems

3. Teach other skills that children find important (allows child to show initiative)

4. Increase child compliance with home behavior plans

5. Help form close friendship between child w/ ADHD with another child

NOTE: For therapy to work, parent + therapist + teacher will work on same goals so that child can practice skills in MULTIPLE SETTINGS

Medication for ADHD - Stimulants vs Non-Stimulants

Stimulants: common ADHD medications; increase dopamine levels in the brain, improving focus/reduce hyperactivity

• Ritalin/Dexedrine/Adderall

  • Academy of Pediatric Guidelines diagnose stimulants as young as 4 YO

  • 70-80% ADHD children get better

    • Child shows less impulsive/distractibility in classroom

    • better social skills

    • fewer auto-accidents

Non-Stimulants: used when stimulants are ineffective/cause side effects. Work slowly but help attention/impulse control

Medication - Ritalin (Stimulants)

Taking Ritalin typically results in fast/temporary improvements in performance

1. helps increase ability to:

   1. pay attention

   2. focus on activity

   3. control behavior problems

   4. organization

   5. listening skills

2. Risk:

   • Nervousness

   • trouble sleeping

   • loss of appetite

   • Weight loss

Problems that May arise due to misuse of prescription stimulants (ADHD)

Misuse of medical stimulants can be a serious problem due to:

1. potential health risk (addiction, heart issues)

2. ethical concerns

3. legal implications (using controlled substances WITHOUT prescription)

4. Drug-dependence instead of proper development

Findings of NIMH (National Institute of Mental Health) Treatment Study on Treatments/Interventions for ADHD

Between Meds Only, Behavior Therapy Only, Meds + Therapy and Routine Care:

1. Meds Alone & Combined Treatment - more effective than Routine care/Behavior therapy alone

2. Combined Treatment - led to less dropout than Meds Alone + improvement of non-ADHD symptoms

3. Group differences lessened over time

How does comorbid diagnoses with ADHD impact proper diagnosis and treatment?

Comorbid conditions (anxiety, depression, LD, ODD) can make diagnosis treatment of ADHD:

• HARDER to diagnose accurately, as symptoms may overlap/mask each other.

• Complicates treatment, required more tailored approach to address both ADHD + co-occurring disorder

• Necessity to use multiple intervention strategies (i.e., combination of medication, therapy and specific supports)

What other mental disorders has ADHD been linked to?

1. Anxiety Disorders

2. Learning Disorders (LD)

3. Oppositional Defiant Disorder (ODD)

4. Conduct Disorder (CD)

5. ASD

6. Speech and Language Impairment

Sleep and ADHD

25-55% of individuals with ADHD report having sleep disturbance

• Relationship between Sleep/ADHD is COMPLEX:

  • Problems w/ sleep can arise due to symptoms of ADHD

  • Problems with sleep ALSO leads to development of ADHD/ADHD-like symptoms

Comorbidity of sleep disorder symptoms and ADHD

Children with disrupted sleep show less executive control, irritation, impulsivity, distractibility and emotional dysregulated.

These symptoms are easily confused with ADHD, resulting in misdiagnosis if the patient is monitored for a short time.

Eating Disorder - Definition

Mental disorder, defined by abnormal eating behaviors that adversely affect a person’s physical mental health

Eating Disorder - Prevalence

• Global Eating Disorder - increased by 4% from 2000-2018

• 9% (28.8M) of the U.S. population suffer from eating disorder

Eating Disorder - Developmental Stages

Infancy/Childhood:

1. Pica

2. Ruminative Disorder

3. Avoidant Restrictive Food intake Disorder (ARFID)

Adolescence/Adulthood

4. Anorexia Nervosa

5. Bulimia Nervosa

6. Binge Eating Disorder

Types of Eating Disorders Prevalent in Infancy/Childhood

1. Pica

2. Ruminative Disorder

3. Avoidant/Restrictive Food Intake Disorder

Pica - Defintion

Persistent eating of nonfood, non-nutritive substances over a period of at least ONE MONTH

• Common among younger children

• Can be life-threatening if continued

• Associated with ID and certain chronic medical conditions (e.g., sickle cell)

Pica - Causes

Etiology:

1. Low environmental stimulation

2. poor parental supervision

3. vitamin deficiencies

4. Other mental disorders (e.g., Autism, OCD)

Pica - Treatment

Treatments focus on BEHAVIORAL STRATEGIES

1. Remove/Block access to dangerous substances

2. Redirection to a preferred activity

3. reinforcing incompatible behavior (positive opposite)

4. Monitor child’s lead levels

Rumination Disorder - Definition

Automatic regurgitation (throwing up) of previously eaten food, re-chewing, and either swallowing it again/spitting it out

Rumination Disorder - Causes and Treatment

Etiology:

• generally develops in early childhood

• common among children with ID

• Cause by self-stimulation/Stress (?)

Treatment

• Behavioral strategies

• habit reversal - working with individual in becoming aware of triggers and REPLACING them with alternative responses

• Overcorrection - intervention strategy used to teach individuals appropriate behaviors by providing additional opportunities to practice correct responses

Avoidant/Restrictive Food Intake Disorder (ARFID) - definition

Disorder characterized by avoidance/restriction of food intake

Usually leads to significant weight loss/failure to maintain normal growth

Avoidant/Restrictive Food Intake Disorder (ARFID) - Etiology

Etiology is multifactorial:

1. Biological

2. Medical

3. Psychological

4. Environmental Factors

5. History of the following:

   1. Vomiting

   2. food allergies

   3. Gastrointestinal difficulties

Avoidant/Restrictive Food Intake Disorder (ARFID) - characterisitcs

1. Weight loss

2. Significant nutritional deficiency

3. Dependence on enteral feeding (feeding tube) OR oral nutritional supplements

4. difficulties in psychosocial functioning

Avoidant/Restrictive Food Intake Disorder (ARFID) - Developmental Trajectories

• Picky Eating - common among younger children (via parent self-report)

  • If the onset of Picky eating occurs during < 2yo, this can have serious developmental consequences

• societal norms + media focus on thinness especially among different gender groups have exacerbated poor eating habits among children

Eating disorders normally found among adolescents and adulthood

1. Anorexia Nervosa

2. Bulimia Nervosa

3. Binge Eating Disorder

Anorexia Nervosa - Definition

Characterized by:

1. Refusal to maintain minimally normal body weight

2. Intense fear of gaining weight

3. Significant disturbance in perception/experiences of body size

Anorexia Nervosa - subtypes

DSM-V identifies TWO specific subtypes of Anorexia Nervosa:

1. Restricting Type - individual wants to lose weight through diet, fasting or excessive exercise

2. Binge eating/purging type - individual regularly engages in episodes of binge-eating, purging, or both

Bulimia Nervosa - Definition/Diagnostic Criteria

Characterized by:

1. Recurrent episodes of binge-eating and associated purging for at least 1 a week for 3 months

2. eating an amount of food that is LARGER than what most individuals would eat in a similar period of time

3. A sense of lack of control during eating

4. Recurrent inappropriate compensatory behavior in order to prevent weight gain (purging)

Purging

Recurrent and inappropriate compensatory behaviors (e.g., throwing up recently eaten food)

Binge

An episode of overeating that normally involves:

1. eating an objectively large amount of food

2. lack of control over what/how much is eaten

Compensatory Behaviors

Intended to prevent weight gain following a binge episode, and this can include behaviors like:

• Self-induced vomiting

• fasting

• misuse of diuretics/diet pills

Binge Eating Disorder

Similar to Bulimia Nervosa Disorder, only it does not involve “compensatory behaviors”, such as throwing up or excessive exercising

Treatment for Anorexia Nervosa

1. Inpatient Treatment - severe AN patients receive 24-hour care in a hospital/treatment center

2. Family-based treatment - parents help their child restore healthy eating relationships via empowering/positive reinforcement

3. Adolescent Focused Therapy -individual therapy designed to help teens with AN learn to emotionally regulate

Less response to treatment

Treatment for Bulimia & Binge Eating Disorder

1. Nutrition planning/consultation

2. Cognitive Behavioral Therapy - helps individuals identify and challenge negative thought patterns and unhealthy behaviors around eating

3. Interpersonal Therapy

4. Appetite Awareness

Name That Disorder: LJ has a history of defiant, angry, and manipulative behavior, including disobeying rules, losing his temper, and blaming others. He often deliberately annoys people and gets into arguments with adults.

Oppositional Defiant Disorder (ODD)

LJ shows a consistent pattern of defiance, anger and irritability. He deliberately annoys others, loses his temper and blames other's for his actions.

Name That Disorder: Mackenzie has a history of stealing, lying, running away, and harming others, including setting a fire and showing no remorse for her actions.

Conduct Disorder (CD)

Mackenzie exhibits a pattern of serious rule violations (stealing, breaking/entering, running away, etc.). She is also physical aggressive, destroys property, and is very deceitful.

Characteristics of Disruptive, Impulse-Control and Conduct Disorders

• These disorders are characterized by problems with self-control of emotions and behaviors

• Problems manifest through behaviors that violate the rights of others and/or conflict with norms/figures

Types of Disruptive, Impulse-Control and Conduct Disorders

1. Intermittent Explosive Disorders - sudden, intense outburst of anger/aggression that is disproportionate to situation

2. Opposition Defiant Disorder (ODD) - persistent, pattern of angry, defiant and vindictive behavior toward authority figures

3. Conduct Disorder (CD) - pattern of violating societal rules and rights of others through aggression, deceitfulness or destructive behavior

4. Pyromania - compulsive urge to deliberately set fires for pleasure

5. Kleptomania - recurrent inability to resist urge to steal

6. Antisocial Personality Disorder - involves chronic pattern of disregarding the rights of others

Among the disruptive, Impulse-control and conduct disorders, which are more likely to appear in childhood?

Opposition Defiant Disorder (ODD) and Conduct Disorder (CD) are more likely to manifest and be diagnoses in childhood

Opposition Defiant Disorder (ODD) - Definition

Characterized by patterns of angry, defiant or vindictive behavior towards authority figures.

Children with ODD show patterns of being uncooperative, defiant and hostile towards peers, parents, teachers and other authority figures

Opposition Defiant Disorder - Diagnostic Criteria

A. 4+ of symptoms that fall under 3 categories (must persist for 6+ months):

1. Angry/Irritable Mood

   • Loses temper

   • sensitive/easy to annoy

   • angry or resentful

2. Argumentative/Defiant Behavior

   • Often argues with authority figures

   • Actively defies/refuses to comply with request from authority figures

3. Vindictiveness

   • spiteful or vindictive (for at least 2x in 6 months)

B. The disturbance in behavior is associated with distress in individual/others in child’s immediate social context.

C. Behavior DOES NOT OCCUR with other disorders (e.g., psychotic, substance-use, depression or bipolar disorder)

Opposition Defiant Disorder (ODD) - Prevalence and Risk Factors

Prevalence

• 3.3% of children (5-17 YO) in US have ODD

• More common in males 4:1

Risk Factors

• comorbid with internalizing disorders (anxiety/depression)

  • Negative emotions experienced in ODD can be expressed as internalized distress

Conduct Disorder (CD) - Definition

Children who display persistent pattern of aggressive and anti-social acts such as inflicting pain on others or interfering in the rights of others through physical/verbal aggression, stealing or vandalism

Conduct Disorder (CD) - Diagnostic Criteria

A. Repetitive pattern of behavior that violates the basic rights of others/societal norms. Manifest as 3+ symptoms from any of the 4 categories:

1. Aggression to People/Animals

   • often bullies or threatens others

   • Initiates physical fights

   • Use of weapon that can cause serious physical harm to others

   • physically cruel to people/animals

2. Destruction of Property

   • Deliberately plays with fire

   • Deliberately destroys other’s property

3. Deceitfulness or Theft

   • Broken into someone’s property

   • lies to obtain goods/favors OR avoid obligations

4. Serious Violations of Rules

   • Stays out at night despite parental prohibition (< 13 YO)

B. Disturbance of behavior causes clinically significant impairment in social/academic/occupational functioning

C. If > 18 YO, must not be comorbid with antisocial personality disorder

Conduct Disorder (CD) - Prevalence and Risk Factors

Prevalence

• 4% of children age 5-17 YO

• More common in males

Risk Factors

• Comorbid with substance use

Subtypes of Conduct Disorder (CD)

1. Childhood-Onset CD

   • Diagnosed for children age < 10 years old

   • Displays of aggression during early childhood

   • More common in males

   • Disturbed Peer relationships

   • If COCD develops, more likely for CD to persistent in adulthood

   • More likely to have “callous-unemotional traits”

2. Adolescent-onset CD

   • Less likely to be emotionally aggressive

   • No differences among gender

   • More normative peer relationships

   • Less likely to have CD in adulthood

Gender Differences in Onset/Diagnosis of Conduct Disorder

Developmental Trajectory via Gender reveal:

1. Preschool - gender differences are NONEXISTENT

2. School-aged - CD/(ODD) 2-3:1 to be diagnosed in boys

3. Adolescence - 2:1, gap closes between boys and girls due to increase rates of diagnosis

Reactive Aggression

Impulsive, defensive RESPONSES to a real/perceived threat

Occurs due to tendency to believe that neutral/ambiguous reactions from peers are actually hostile

Proactive Aggression

PLANNED, goal-directed behavior design to achieve an objective by provoking aggression

Usually premeditated/planned

occurs due to delinquency and alcohol abuse in adolescence (criminality in adulthood)

Causes of ODD + CD (Disruptive, Impulse-Control and Conduct Disorders)

2 theories of etiology of ODD + CD

1. Biosocial Theory

2. Vile Weed Theory

Biosocial Theory (Moffitt, 1993)

Suggest that ODD/CD (antisocial behaviors) arise from complex interaction of different biosocial factors. These interactions manifest as either:

1. ADOLESCENT-limited Antisocial Behavior (AL)

   • antisocial behaviors that are restricted to adolescent years

   • CD/ODD caused AND maintained by imitating delinquent peers + reinforcement from peers

2. LIFE-COURSE persistent antisocial behavior (LCP)

   • Antisocial behavior emerges in early childhood and PERSIST into adulthood

   • Throughout development, CD/ODD symptoms/behaviors persist (not as common!)

Time course of Life-Course persistent antisocial behavior

Vile Weed Theory (Patterson)

CD/ODD gets WORSE and MORE INTRACTABLE (cannot be reversed) over time.

This is similar to the growth of a weed

Causes of CD/ODD Explained by the Vile Weed Theory

Theory explains that CD/ODD are rooted in

• Ineffective parenting

• Poor parental monitoring/poor supervision

• Poor discipline

• Parents modeling coercive behavior to their children (e.g., “I won’t love you if you do X”)

4 Developmental Stages according to the Vile Weed Theory

Preschool (Stage 1) - Child learns negative behaviors by observing parents (negative modeling)

School Age (Stage 2) - Negative behaviors lead to social rejection, reinforcing antisocial patterns

Adolescence (Stage 3) - Child associates with deviant peers, exacerbated negative behaviors w/ lack of supervision

Adulthood (Stage 4) - Antisocial behaviors are engrained, leading to chronic deviant behaviors.

Psychopathy

Interpersonal Style characterized by persistent antisocial behavior, selfishness, lack of remorse, impulsivity and callous/emotional traits

Interpersonal Style

Person’s typical behaviors when interacting with others

Examples of “callous” or “unemotional” traits displayed in psychopathy

• lacking guilt

• no empathy

• shallow emotions

• charming/insincere