Psychopathology Childhood Disorders

Externalizing childhood disorders

ADHD, conduct disorder

ADHD diagnostic criteria

1. 6+ innatentive symptoms for 6+ months, maladaptive, abnormal for developmental level or

2. 6+ hyperactive symptoms for 6+ months

3. symptoms present before 12

4. in two or more settings

5. impairing social, academic, occupational functioning

ADHD prevalence rate explanation

diagnosis by unqualified pediatricians and differing educational policies

ADHD male to female ratio

3:1

ADHD into adulthood

symptoms decline with age but rarely go away

ADHD comorbidities

internalizing disorders (0.3), learning disorders (0.15-0.3), conduct disorder (0.25-0.45)

ADHD subtypes

inattentive, hyperactive, combined

ADHD + conduct disorder outcomes

antisocial behaviors, peer rejection, poor academic outcomes, worse prognosis

ADHD genetic etiology

1. highly heritable (0.7-0.8)

2. dopamine linked gene (DRD4 DRD5 DAT1)

3. gene for synaptic elasticity promoting protein (SNAP-25)

ADHD neurobiological etiology

1. dopaminergenic brain regions are smaller

2. less activation in frontal brain regions → impaired selective attention, working memory, and inhibiting behavioral response

ADHD and environmental toxin correlations

1. artificial food coloring weak

2. lead blood concentration weak

3. maternal smoking moderate but bidirectional

ADHD family factor etiology

little evidence for causality

ADHD medical treatment

1. stimulant medications improve concentration, executive function, relationships, and behavior

2. more effective than therapy, most effective in combination

3. half of the standard dose may be sufficient

ADHD psychological treatment

1. parent training and changes in classroom management, monitoring and reinforcement of behavior

2. intensive behavioral therapy (=ritalin+less intensive BT)

Conduct disorder diagnostic criteria

1. persistent violation of basic rights of others or social norms as shown by 3+ symptoms

2. aggression to people and animals, destruction of property, deceitfulness or theft, and serious violation of rules

3. impairment

Conduct disorder prevalence

0.02-0.1

Conduct disorder prognosis

if life course persistent, violent and antisocial behavior often develops

Conduct disorder comorbidities

1. substance abuse

2. internalizing disorders (especially anxiety and depression)

3. ADHD

Conduct disorder genetic etiology

1. aggression is more heritable than rule-breaking

2. conduct problems combined with unemotional/callous are more heritable than conduct problems alone

3. earlier means more genetically linked

4. MAOA (monoamine transmitters), 5HTTLPR (serotonin)

Conduct disorder neurophysiological etiology

1. deficits in regions for emotion and empathy → difficulty detecting emotions other than anger

2. reduced activation of brain regions for emotion and reward → difficulty associating behavior with consequence

3. deficits in verbal skill, executive function, and memory

Conduct disorder psychological etiology

1. unemotional/callous → low moral awareness and remorse

2. aggressive → hostile bias

Conduct disorder and peer influence

1. being rejected by peers is causally related to aggression

2. modeling or coercion in association

Conduct disorder treatments

family interventions, multi systemic treatment

Conduct disorder family interventions

1. family checkup → three assessment and feedback meetings regarding child and parenting, less aggression and misconduct

2. parent management training → awarding prosocial not antisocial behavior, better parental interactions and less aggression and antisocial behavior

Conduct multi systemic treatment

1. intensive therapy in community (family, school, and peer group) to address underlying factor

2. behavioral, cognitive, and educational treatment

Childhood depression symptoms that are the same as adults

1. depressed mood

2. anhedonia

3. fatigue

4. concentration problems

5. SI

Childhood depression symptoms that are diffrent from adults

1. more guilt

2. less early morning wakefulness and depression

3. less appetite and weight loss

Childhood depression prognosis

mostly persists to adulthood

Childhood depression male to female ratio

1:2

Childhood depression family etiology

children with depressed parents 4x as likely to develop

Childhood depression gene-environment etiology

short 5HTTP gene allele combined with stressful life event

Childhood depression social etiology

early life adversity (mostly not limited to home)

Childhood depression psychological etiology

1. cognitive distortions and negative attributional style increases risk

2. usually becomes stable in middle school, serves as a cognitive diathesis

Childhood depression treatment

1. Prozac is more effective than therapy, most effective in combination with therapy

2. Increase suicidality and cause many physical side effects

3. CBT is most effective therapy

Childhood anxiety symptoms similar to adults

1. impaired functioning

2. severe distress

3. avoidance

Childhood anxiety symptoms different from adults

do not need to regard fear as irrational

Childhood anxiety prevalence

3-5%

Childhood anxiety heritability

moderate (0.29-0.5)

Childhood anxiety social etiology

1. parental control and overprotectiveness (moderate)

2. parental rejection (mild)

3. bullying (moderate)

Childhood anxiety psychological etiology

overestimate danger of social situations and underestimate ability to cope

Childhood PTSD risk factors

family stress and coping styles

Separation anxiety disorder diagnostic criteria

developmentally inappropriate and excessive anxiety about separation from attachment figures with 3+ for 4+ weeks (6+ months in adults)

1. distress when deparated

2. worry something bad will happen to figure

3. refusal to go to school, work, or elsewhere

4. refusal to sleep away from home

5. nightmares about separation from figure

6. physical complaints when separated from figure

Childhood anxiety treatment

1. CBT → reframing fears, exposure training, relapse prevention

2. BT and group CBT → best for social anxiety

3. bibliotherapy → parent roleplays as therapist

Specific learning disorder diagnostic criteria

1. difficulties learning basic academic skills inconsistent with age, schooling, intelligence for 6+ months

2. interference with academic achievement or daily life

Specific learning disorder types

1. dyslexia (reading)

2. dyscalulia (math)

3. written expression impairment

Dyslexia etiology

1. heritable component, genes associated with reading ability

2. disrupted connectivity between regions for phonological awareness and regions that support speech production

Dyslexia treatment

1. phonological awareness training

2. instructional support accomodation (podcast, recorded lectures, tutors, no time limit)

Intellectual disability diagnostic critieria

1. intellectual deficits determined by intellectual testing and broader clinical assessment

2. deficits in adaptive functioning relative to age and cultural groups in: communication, social participation, work or school, independence, need for support

3. onset during child development

Down syndrome genetic etiology

extra copy of chromosome 21 causes intellectual disability and characteristic physical abnormalities

Fragile X syndrome genetic etiology

mutation of the Fm1 gene on the X chromosome causes large underdeveloped ears, a long thin face, and often intellectual disability or specific learning disorder

Recessive gene and intellectual disability

1. phenylketonurea causes deficiency of liver enzyme phenylalanine causing build up of phenylperuvic acid

2. can cause brain damage and intellectual disability

Intellectual disability and infectious disease

in utero exposure to infectious diseases like HIV, rubella, or herpes

Environmental hazards and intellectual disability

exposure to mercury or lead

Intellectual disability treatment

1. residential treatment → when individuals cant function in their community, part time or full time

2. behavioral treatment → specific behavioral objectives and step by step learning to improve functioning

3. cognitive treatment → speech guided problem solving

4. computer assisted instruction

ASD symptoms

1. 1+ deficit in social communication and social interactions

2. 2+ restricted repetetive behaviors, interests, or activities

ASD social communication and interaction symptoms

1. deficit in social or emotional reciprocity

2. deficits in nonverbal behaviors

3. deficit in development of peer relationships appropriate at age level

ASD repetitive or restricted behaviors

1. stereotyped or repetitive speech, movement, or use of objects

2. excess adherence to routines, rituals, or extreme resistance to change

3. very restricted interests that are abnormal in focus

4. hyper or hypo reactivity to sensory input or unusual interest in sensory environment

5. onset in early childhood

6. symptoms limit and impair functioning

ASD communication deficits

echolalia and pronoun reversal

ASD comorbidity

1. intellectual disability (often with profound sensorimotor function)

2. specific learning disorder (0.3)

3. anxiety disorders

ASD prevalence

1/68 children

ASD male to female

4:1

ASD onset

begins in early childhood and can be detected in the first months of life

ASD prognosis

1. children with higher IQ and speech acquisition before 6 have better outcomes

2. most do not require residential care and some can go to college and have a job

3. most continue to have impaired social relationships throughout their life

ASD genetic etiology

1. highly heritable (0.5-0.8)

2. specific genes underlying autism not identified

ASD neurobiological etiology

1. larger brains, neurons not pruning correctly

2. larger cerebellum, explore their surroundings less

3. larger amygdala in childhood, predicts difficulties communicating and socializing

4. smaller amygdala in adulthood, preducts difficulties in emotional perception

ASD medicinal treatment

antipsychotic medications treat behavioral problems but are less effective than therapy

ASD behavioral treatment

1. intense operant conditioning in all aspects of childs life for 40+ hrs a week for 2+ yrs

2. larger IQ increase and better educational outcomes