CLPS 702 Review for Midterm #2

K-SADS

Kiddie Schedule for Affective Disorders and Schizophrenia

What is K-SADS purpose?

● Semi-structured diagnostic interview used to assess psychiatric disorders in children and adolescents

● Can be used to diagnose ASD

○ Questions about:

■ Stereotyped or repetitive speech, motor movements, or use of objects

■ Insistence on sameness, inflexible adherence to routines, ritualized patterns of verbal and nonverbal behavior

■ Highly restricted, fixated interests that are abnormal in intensity or focus

ADOS-2

Autism Diagnostic Observation Schedule - Second Edition

What are the five modules of ADOS-2?

Five modules:

○ Toddler module

■ 12-30 months old; do not consistently use phrase speech

○ Module 1

■ Children 31 months and older who do not consistently use phrase speech

○ Module 2

■ Children any age who use phrase speech, but are not verbally fluent

○ Module 3

■ Verbally fluent children and young adolescents

○ Module 4

■ Verbally fluent older adolescents and adults

Severity Levels of ASD

● Level 3: Requiring very substantial support

○ Severe deficits in verbal and nonverbal communication, inflexibility of behavior and extreme difficulty coping with change

● Level 2: Requiring substantial support

○ Deficits in verbal and nonverbal communication, difficulty coping with change and inflexible behavior

● Level 1: Requiring support

○ Withouts supports - deficits in social communications causing impairments, and inflexible behavior causes interference in functioning

Applied Behavior Analysis (ABA)

modern term for a form of behavior modification that uses shaping techniques to mold a desired behavior or response

Inattention symptoms of ADHD

○ Fails to pay close attention to details

○ Difficulty sustaining attention in tasks or play

○ Not listening when spoken to

○ Struggling to follow through on instructions

○ Difficulty organizing/messy

○ Often avoids or is reluctant to engage in tasks that required sustained mental effort

○ Often loses things necessary for tasks

○ Becomes easily distracted and jumps from activity to activity

○ Forgetful in daily activities

Hyperactivity Symptoms of ADHD

○ Fidgeting and squirming / trouble sitting still

○ Leaves seat when being seated is expected

○ Runs or climbs on things

○ Difficulty doing quiet tasks

○ Often "on the go" or "driven by a motor"

○ Talks excessively

Impulsivity Symptoms of ADHD

○ Blurts out answers

○ Difficulty taking turns or waiting

○ Difficulty sharing

○ Interrupts of intrudes on others

DSM 4 # of symptoms required for ADHD

6 or more in either inattention orhyperactivity-impulsivity

DSM 5 # of symptoms required for ADHD

6 or more in either domain if <17

DSM 4 age of symptom onset for ADHD

<7 years

DSM 5 age of symptom onset for ADHD

<12 years

DSM 4 impairments at onset for ADHD

Onset of impairment <7 years

DSM 5 impairments at onset for ADHD

not required

DSM 4 Pervasiveness for ADHD

"Evidence of impairments in 2 ormore settings"

DSM 5 Pervasiveness for ADHD

"Evidence of symptoms in 2 ormore settings"

DSM 4 Autism exclusionary? for ADHD

Yes

DSM 5 Autism exclusionary? for ADHD

No

Medications for ADHD

○ Stimulants (e.g. Adderall, Ritalin): act on excitatory neurotransmitters

- Norepinephrine: alertness, attention, arousal, impulse control

- Dopamine: reward, motivation, movement

- First-line medication: fast acting

○ Non Stimulants

- Norepinephrine: alertness, attention, arousal, impulse control

- Second-line medication: stimulants don't work, or to avoid side effects, slower acting

ADHD & ODD overlap

- irritability

- difficulty managing and regulating emotions

- intense meltdowns/tantrums

- tendency to move when expected to sit

- purposely annoys others

- stimulus seeking

Impulsive Aggressive Spectrum

ODD --> CD --> IED

Biopsychosocial model in relation to children

Biological Factors:

- Nutrition & Physical Health: Malnutrition, deficiencies (e.g., iron, omega-3), and chronic illnesses can affect cognitive and emotional development.

- Neurodevelopment: Brain development, including issues related to prenatal exposure to toxins, birth complications, or head injuries, can influence mental health.

Psychological Factors:

- Attachment Style: Secure vs. insecure attachment with caregivers can shape emotional regulation and stress responses.

- Trauma & Adversity: Exposure to abuse, neglect, or household dysfunction (e.g., parental divorce, substance abuse) increases the risk of disorders like anxiety and depression.

Social Factors:

- Parental Influence: Parenting style (authoritative vs. authoritarian/permissive), warmth, and discipline impact mental well-being.

- Socioeconomic Status: Poverty, unstable housing, and food insecurity create chronic stress and affect mental health outcomes.

Trends in ADHD

● ADHD is more frequent in males than females

○ Females are more likely to present primarily with inattentive features

○ Sex difference may be due to different genetic and cognitive liabilities between sexes

● ADHD prevalence is higher in special populations (e.g foster children) or in correctional settings

● Risk factors

○ Temperament

○ Perinatal factors

○ Visual and hearing impairments

○ Metabolic abnormalities

○ Nutritional deficiencies

Trends in ASD

● ASD occurs in 1-2% of the US population, ~1% globally

● ASD prevalence is lower among US African American and Latinx children than white children

● ASD is more frequent in males than females (3:1)

● Concerns about under diagnosis in women and girls

● As many as 15% of cases of ASD appear to be associated with a known genetic mutation

● Vaccines do not cause Autism

Trends in Depression & Anxiety

● Nearly 1 in 3 teens ages 13-18 has an anxiety disorder

● Major Depression is more prevalent in 12-17 year olds than those ages 26+, and rates are rising

● Suicide rates increased among youths from 2000 to 2017

○ Ages 10-14: 67% increase

○ Ages 15-19: 48% increase

○ Ages 20-24: 36% increase

● Suicide is the 2nd leading cause of death among 10-24 year olds

● Suicide impacts some communities, including LGBTQ youth, more than others

● Many people first experience mental health symptoms in adolescence

● 75% of all lifetime mental illness develops by 24

● Anxiety and depression are the most common mental illnesses

Substance Use in Adolescence

○ Substance use is linked to numerous mental health concerns

○ Many adolescents use as "self-medication"

○ Some evidence indicates that substance use increases mental health symptoms

○ Psychiatric conditions are linked to greater use and more potent routes of administration (e.g., vaping)

○ Substance use, and especially marijuana use, is linked to greater suicidal thoughts and behaviors

○ This may be partially due to engaging in more impulsive and risky behavior

Risky and Impulsive Behavior in Adolescence

○ There are a lot of factors that influence criminal behavior in youth

○ 90% of kids who break the law during adolescence don't become adult criminals

○ Criminal and deviant activities are associated with substance use

○ Adolescents in the justice system have very high rates of mental health concerns

○ Adolescents involved in the justice system are often not receiving treatment for mental health treatment

Sleep in Adolescence

○ Brain changes influence circadian rhythm

○ Shifts sleep ~2 hours later

○ Increased sleep pressure

○ More sleep needed (9-10 hrs)

○ Prefrontal development is sensitive to sleep disruption

○ Potential long-term impact on mental health

○ Insufficient and poor-quality sleep is associated with a host of mental health difficulties

Disruptive mood dysregulation disorder is characterized by all of the following, except:

a. Episodic periods of mood impairments, like in bipolar disorder

b. Persistent irritability

c. Frequent temper outbursts

d. Symptoms must be present before age 10

a)

True or False: Separation anxiety can only happen in children (not adults)

False

Separation anxiety can be in relation to:

a. Caregivers

b. Spouses

c. Children

d. Parents

all of the above

Which of the following best describes Conduct Disorder (CD)?

a. Excessive worry and fear about social situations

b. Persistent disregard for the rights of others and societal rules

c. Difficulty paying attention and staying focused

d. Frequent anger and depressive episodes.

b

Which level of Autism Spectrum Disorder (ASD) is the most severe,requiring the highest level of support?

a. Level 1

b. Level 2

c. Level 3

d. ASD is not categorized by severity

c

Which of the following is NOT a symptom category of ODD?

a) vindictiveness

b) destruction of property

c) argumentative/defiant behavior

d) angry/irritable mood

b

Major depressive disorder (MDD)- differences in children vs. adults

Irritable mood can be an essential feature symptom over depressed mood in adolescents and children

Challenges in Diagnosing Bipolar Disorder in Children

Overlap with ADHD & Disruptive Disorders - Children with bipolar disorder often show hyperactivity, impulsivity, and mood instability, leading to misdiagnosis as ADHD.

Rapid Cycling - Mood shifts multiple times a day, making it harder to classify distinct manic and depressive episodes.

Expression of Mania - Instead of euphoric mania, children often exhibit severe irritability and rage.

Parental Reports - Diagnosis relies on parent/teacher observations, which may be inconsistent.

What are the mood episode characteristics of bipolar disorder in children?

More chronic and mixed—frequent mood shifts throughout the day (ultra-rapid cycling).

What are the mood episode characteristics of bipolar disorder in adults?

More distinct and episodic—clearer manic and depressive phases.

What are the manic symptoms of bipolar disorder in children?

Severe irritability, explosive tantrums, aggression, hyperactivity, decreased need for sleep.

What are the manic symptoms of bipolar disorder in adults?

Euphoric mood, grandiosity, impulsivity, risky behaviors.

What are the depressive symptoms of bipolar disorder in children?

Low energy, social withdrawal, physical complaints (stomachaches, headaches).

What are the depressive symptoms of bipolar disorder in adults?

Sadness, hopelessness, fatigue, suicidal thoughts.

What is the cycling pattern of bipolar disorder in children?

Rapid, multiple mood shifts in a day (ultradian cycling).

What is the cycling pattern of bipolar disorder in adults?

Longer episodes (weeks to months of mania or depression).

What psychotic features may occur in children with bipolar disorder?

Hallucinations and delusions may occur during mood episodes.

What psychotic features may occur in adults with bipolar disorder?

More common in manic episodes, may be mistaken for schizophrenia.

What is the nature of suicidality in children with bipolar disorder?

More impulsive self-harm rather than planned suicidal behavior.

What is the nature of suicidality in adults with bipolar disorder?

Higher risk of planned suicide attempts.

What are common comorbidities in children with bipolar disorder?

ADHD, anxiety disorders, oppositional defiant disorder (ODD), conduct disorder.

What are common comorbidities in adults with bipolar disorder?

Substance use disorder, anxiety disorders.

What are the key features of temper outbursts in DMDD according to DSM-5?

Severe, recurrent temper outbursts (verbal or behavioral) that are out of proportion in intensity or duration to the situation and inconsistent with developmental level.

How often do temper outbursts occur in DMDD?

Outbursts occur at least three times per week on average.

What is the mood between outbursts in DMDD?

Persistent irritability or angry mood present most of the day, nearly every day, observable by parents, teachers, or peers.

What is the duration requirement for DMDD symptoms?

Symptoms must persist for 12 months or more without a break of more than 3 months.

In how many settings must DMDD symptoms be present?

Symptoms must be present in at least two of three settings (home, school, with peers) and severe in at least one.

What is the age of onset for DMDD symptoms?

Symptoms must appear before age 10, but the diagnosis is not made before age 6 or after age 18.

What disorders cannot be diagnosed alongside DMDD?

Bipolar disorder, oppositional defiant disorder (ODD), or intermittent explosive disorder.

What conditions must be ruled out for a DMDD diagnosis?

Symptoms cannot be explained by another mental disorder (e.g., depression, autism) and must not be due to substance use or a medical condition.

What are the three deficits in social communication and interaction required for an autism diagnosis?

Deficits in social-emotional reciprocity, nonverbal communication, and developing/maintaining relationships.

What is an example of a deficit in social-emotional reciprocity?

Difficulty with normal back-and-forth conversation.

What is an example of a deficit in nonverbal communication?

Poor eye contact.

What is an example of a deficit in developing, maintaining, and understanding relationships?

Difficulty making friends.

What is required for the restricted, repetitive behaviors and interests criterion in autism diagnosis?

At least 2 behaviors or interests must be present.

What is an example of stereotyped or repetitive movements in autism?

Hand-flapping.

What does inflexibility and insistence on sameness refer to in autism?

Extreme distress at small changes.

What is an example of a highly restricted, intense interest in autism?

Strong attachment to unusual objects.

What is hyper- or hyporeactivity to sensory input in autism?

Extreme sensitivity to sounds.

When must symptoms of autism be present?

In early childhood.

What must the symptoms of autism cause?

Significant impairment in daily life.

What must be ruled out for an autism diagnosis?

Other disorders such as intellectual disability or social anxiety.

DSM-5 Diagnostic Criteria for Separation Anxiety Disorder

To be diagnosed with SAD, an individual must experience at least 3 of the following symptoms for at least 4 weeks in children and 6 months in adults, causing significant distress or impairment in daily life:

1. Excessive distress when anticipating or experiencing separation from home or attachment figures.

2. Persistent worry about losing, or harm coming to, an attachment figure (e.g., fear of illness, accidents, kidnapping).

3. Excessive worry about experiencing an event (e.g., getting lost, being kidnapped) that would cause separation from an attachment figure.

4. Reluctance or refusal to go out (e.g., to school, work, social settings) due to fear of separation.

5. Fear of being alone or without attachment figures at home or other settings.

6. Reluctance or refusal to sleep away from home or without an attachment figure nearby.

7. Repeated nightmares about separation.

8. Physical symptoms (e.g., headaches, stomachaches, nausea) when separation is anticipated or occurs.

How do children typically re-experience trauma in PTSD?

Children may have vague or unrelated nightmares and often re-enact trauma through play or drawings.

How do adults typically re-experience trauma in PTSD?

Adults often experience flashbacks and intrusive memories that are more detailed and explicit.

What is a common avoidance behavior in children with PTSD?

Children may avoid people, places, or activities but struggle to verbally express why.

What is a common avoidance behavior in adults with PTSD?

Adults exhibit more conscious avoidance of triggers, conversations, and situations related to the trauma.

What mood and cognition changes are common in children with PTSD?

Children are more likely to develop separation anxiety, guilt, or a belief that they are bad.

What mood and cognition changes are common in adults with PTSD?

Adults often have negative beliefs about self, others, or the world, such as 'I am unlovable' or 'The world is dangerous.'

What hyperarousal symptoms are common in children with PTSD?

Children may exhibit increased irritability, temper tantrums, hyperactivity, and difficulty sleeping.

What hyperarousal symptoms are common in adults with PTSD?

Adults often experience hypervigilance, exaggerated startle response, insomnia, and difficulty concentrating.

How do children with PTSD typically regulate their emotions?

Children may show frequent mood swings, outbursts, aggression, or withdrawal.

How do adults with PTSD typically regulate their emotions?

Adults may experience more numbing, dissociation, depression, or substance use.

How do children with PTSD perceive time related to their trauma?

Children may experience distorted timelines, thinking the trauma is still happening.

How do adults with PTSD perceive time related to their trauma?

Adults are more likely to recognize that the trauma occurred in the past but still feel its emotional weight.

What is required for a diagnosis of Oppositional Defiant Disorder (ODD)?

At least 4 symptoms from specified categories, lasting at least 6 months, occurring with someone who is not a sibling, and more severe than typical for the child's developmental level.

What are the symptoms of Angry/Irritable Mood in ODD?

Often loses temper, often touchy or easily annoyed, often angry and resentful.

What are the symptoms of Argumentative/Defiant Behavior in ODD?

Argues with authority figures, actively defies or refuses to comply with requests or rules, deliberately annoys others, blames others for their own mistakes or misbehavior.

What is a symptom of Vindictiveness in ODD?

Has been spiteful or vindictive at least twice in the past 6 months.

DSM-5 Diagnostic Criteria for Conduct Disorder

To be diagnosed with CD, a child or adolescent must exhibit at least 3 of the following 15 symptoms in the past 12 months, with at least 1 symptom present in the past 6 months. These behaviors must cause significant impairment in social, academic, or occupational functioning.

1. Aggression Toward People or Animals

Bullies, threatens, or intimidates others.

Initiates physical fights.

Has used a weapon that can cause serious harm (e.g., bat, knife, gun).

Has been physically cruel to people.

Has been physically cruel to animals.

Has stolen while confronting a victim (e.g., mugging, armed robbery).

Has forced someone into sexual activity.

2. Destruction of Property

Deliberately engaged in fire-setting with the intention to cause damage.

Deliberately destroyed property (other than by fire).

3. Deceitfulness or Theft

Broken into someone's house, building, or car.

Lies to obtain goods or favors or to avoid obligations ("conning" others).

Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, forgery).

4. Serious Violations of Rules

Stays out late at night despite parental prohibitions (before age 13).

Runs away from home overnight at least twice (or once for an extended period).

Often skips school (before age 13).

Risk Factors and Causes of CD

Genetic Factors - Family history of ASPD, mood disorders, or substance abuse.

Environmental Factors - Childhood abuse, neglect, exposure to violence.

Neurological Factors - Differences in impulse control, emotional regulation, and empathy processing.

Treatment for CD

Parent Management Training (PMT) - Helps parents reinforce positive behavior.

Cognitive Behavioral Therapy (CBT) - Teaches emotional regulation and impulse control.

Multimodal treatment programs - Targets behavior in family, school, and community settings.

Medication (if needed) - Used to manage co-occurring conditions (e.g., ADHD, aggression).

Causes and Risk Factors of ODD

Genetic Factors: Family history of mood disorders or ADHD.

Environmental Factors: Harsh or inconsistent parenting, neglect, or exposure to aggression.

Neurological Factors: Differences in impulse control and emotional regulation.

Treatment Approaches for ODD

Parent-Child Interaction Therapy (PCIT) - Helps improve parent-child relationships.

Cognitive Behavioral Therapy (CBT) - Teaches coping skills and emotion regulation.

Behavioral Interventions - Positive reinforcement and consistent discipline.

ADHD Psychosocial Therapies

○ Cognitive Behavioral Therapy (CBT)

- helps individuals identify and modify negative thought patterns and behaviors, improving focus,organization, time management, and impulsivity, ultimately enhancing daily functioning and quality of life.

○ Parent Training

- Behavior management, reinforcement, structure, expectations

○ Educational Accommodations

- Limiting distractions, movement breaks, visual cues, step by step guides, extra times, test taking in distraction free locations, etc.

What are early interventions for ASD?

Early diagnosis and focus on early developmental skills

What is Applied Behavior Analysis (ABA) used for in ASD treatment?

Teaches/shapes specific skills and reduces challenging behavior

What does Speech-Language therapy focus on in ASD treatment?

Focuses on communication both verbal and nonverbal

What is the focus of Occupational therapy in ASD treatment?

Focuses on self-care, sensory processing, and fine motor skills

What does Physical therapy address in ASD treatment?

Focuses on gross motor skills, coordination, and balance

What is the purpose of Social Skills training in ASD treatment?

Helps improve social interactions and relationships