Abnormal Psych Unit 4 Childhood Disorders and Ethical Issues

What are the different childhood disorders?

Externalizing Disorders (Undercontrolled)

• ADHD

• Oppositional Defiant Disorder (ODD)

• Conduct Disorder

Internalizing Disorders (Overcontrolled)

• Separation Anxiety

• Phobias

• Depression

What is ADHD

persistent inattention, hyperactivity, and impulsivity that can interfere with functioning or development.

What is the onset of ADHD?

Typically get diagnosed in school years

Does not mean onset is in school years

• It may be earlier and they only find out when they have to be in a strict school setting

What is the prevalence of ADHD?

Well, what is the ZIP code?

Males more than females. 12%/6%

What are the predictors of ADHD?

IQ

• The higher the IQ, more likely for a positive outcome

Aggression

• No real connection between aggressiveness and ADHD

• Kids who have more aggressive symptoms are more likely to have worse outcomes

What are the causes (etiology) of ADHD?

Physiological Theories

Psychological Theories

Integrative Theories

What are the physiological theories of ADHD?

Food Additives, Sugar, vaccines, etc.

Minimal Brain Damage

• MRI studies find no brain damage

Brain Underarousal

Brain Volume Differences

What are the psychological theories of ADHD?

Chaotic Environments

Ineffective Parenting

Sociocultural

What are the chaotic environments in the psychological theories?

Chaotic environments would cause chaotic behavior

• Not much evidence

What is ineffective parenting in the psychological theories?

Parents do not teach people to focus and behave create ADHD

• Not much evidence

What is the sociocultural factors in the psychological theories?

ADHD is more common in well-developed countries

• Education creates ADHD

What are the integrative theories in ADHD?

Diathesis Stress

Developmental Lag

Combination of sociocultural

What is final common pathway in integrative theory?

Many different ways to develop ADHD but once you get there its all the same

What is developmental lag in integrative theory?

Expect them to do things that are made for their age

Inability to match expectations to the current developmental stage in a child is the problem

Combination of sociocultural

What are the ADHD treatments?

Pharmacological

Behavioral Management

Cognitive (for adolescents)

Combined Treatments

What are the pharmacological treatments in ADHD?

Stimulant Medication (e.g. Ritalin, Amphetamine)

(Clear short-term effects on behavior: little evidence of long-term effects on learning)

(Good results depend on skilled management!)

• Multiple side effects

Atomoxetine (Strattera), viloxazine (Qelbree), and other reuptake inhibitors

• Don’t work as well for controlling behavior but fewer side effects

  • Stimulants - Little evidence that helps kids learn more, don't touch attentional aspects of the disorder

What is behavioral management treatment in ADHD?

Requires more resources

• Skilled therapists and time from competent teachers and parents

What is cognitive treatment for ADHD?

Higher IQ kids to better with cognitive treatments

What is conduct disorder?

Rule Violations

• Aggression

• Destructiveness

• Dishonesty

• Other rule breaking (status offenses)

What are the two types of conduct disorder?

Adolescent-limited

Life-course persistent

What is adolescent-limited conduct disorder?

Have these problems in childhood then goes into adolescence and then it just stops

What is life-course persistent conduct disorder?

Continue to have problems into adulthood. Likely to transfer over to antisocial personality disorder

Why does conduct disorder have poor (and costly) outcomes?

Health problems

Inability to maintain relationships

Everything goes wrong

What are the causes (etiology) of conduct disorder?

Biological/Gentic

Psychoanalytic

Social Learning (Patterson)

Link to Antisocial Personality

What is the biological/genetic cause of conduct disorder?

Temperament as a marker?

• At 6 months you can tell when a kid will have conduct disorder

Some unknown set of genes increases the likelihood of conduct disorder

• Search has been unsuccessful

What is the psychoanalytic cause of conduct disorder?

Have failed to develop a superego (part of brain that follows rules)

What is the social learning cause of conduct disorder?

Monitoring

• Better monitoring better way to control your kids

Coercion

Inconsistency

Modeling/Peers

• Parents or peers modeling antisocial behavior

What is link to antisocial personality to conduct disorder?

Everyone who has antisocial personality disorder as an adult had symptoms of conduct disorder as a child

HOWEVER only a ⅓ of children who have conduct disorder as a child end up having antisocial personality disorder as an adult

What is the treatment for adolescents who have conduct disorder?

Psychoanalytic/Traditional Therapy

Residential Programs (Achievement Place)

• Provide support, develop skills they need, then leave and go to real world

Behavioral Skills Training

What is the treatment for children who have conduct disorder?

Psychoanalytic/Play Therapy

Behavioral Family Therapy/Parent Training

• Help parents be good at monitoring and help you win arguments so you avoid coercion process

• Most promising so far

What is Oppositional Defiant Disorder (ODD)?

Anger

Defiance

Vindictiveness

Early Conduct disorder or something else?

• Get diagnosis at age 3 or 4

What is the treatment for ODD?

Parent Training/Behavioral Family Therapy

How are childhood disorders different from adult disorders?

Homotypic Continuity (Connection across time)

• Consistent and looks the same

Heterotypic Continuity (Connection across time)

• Different expression of same thing

  • E.g., arguing in childhood then turns into depression into adulthood

Or discontinuity?

• Things happen in childhood then is gone in adulthood

Example of homotypic continuity

Depression/OCD/PTSD

Example of heterotypic continuity

Separation Anxiety Disorder

School refusal/school phobia

What are the ethical issues in abnormal psych?

The Belmont Report

Instantiated in “The Common Rule”

What is the Belmont Report?

Lays out necessary aspects of ethical research in abnormal psych

Respect for Persons

• Fully informed

  • Have to be aware to participate

• Voluntary consent

  • Can’t have money held over their head

  • Some are not psychologically well enough to give consent

Beneficence

• Benefit/Risk

  • Work very hard to have the best ratio of benefits to risk

  • Researcher maximize benefits and little risk

Justice

• The same groups that take on the burden of research should receive the benefits of research

What are the legal issues in abnormal psych?

The Insanity Defense

Competency to Stand Trial

Civil Commitment

What is the insanity defense?

Definitions

• Unable to tell right from wrong

• Product of an irresistible impulse

• Product of a mental disease

At the time of the Crime

• Only has to do with their mental status at the time of the crime

  • Could be fine at trial, only matter when the incident happens

Once the trial is done, it’s done

Very few cases!

Guilty but mentally ill alternative

• 1st step is they are guilty of crime point blank, 2nd step they decide if they are mentally ill or not and may give them treatment instead

What is competency to stand trial?

At the time of the trial

• Mental status matters at the time of the trial

  • If they are no longer competent, they cannot have the trial

Subject to periodic review

What is civil commitment?

Crime has not happen, if someone is mentally well you have the right to civilly committed to a hospital to protect them

• Within 48 hours they have to go before a judge

Not criminal

Subject to periodic review