Childhood disorders

164 - 170

What are behavioural disorders

disruptive, impulse control, and conduct disorders

What is oppositional defiant disorder

• pattern of angry

• irritable mood

• argumentative

• defiant behaviour

• vindictiveness

• losing temper

• arguing

• defying rules

• deliberately annoying/being easily annoyed

• shifting blame

• resentful

What is a conduct disorder

• involves serious behaviours that violate the rights of others or societal norms

• bullying and threatening

• intimidating others

• physical fighting, cruelty towards people or animals

• stealing

• destroying property

• running away, truancy

Risk factors of behavioural disorders

• Genetic factors (twin studies) and familia psychopathology

• Neurocognitive deficits: executive functioning, emotion recognition

• Abnormalities in the prefrontal cortex and amygdala temperamental/personality predispositions

  • E.g. impulsivity, poor emotion regulation

• Socioeconomic deprivation and inequality

• Parenting

  • E.g. ineffective discipline, low levels of support, parental rejection or neglect/abuse, poor supervision

• Peer relationships

  • E.g. association with deviant peers, peer rejection, being bullied

• Stressful life events

  • E.g. death of caregiver, parental divorce

• School climate and neighbourhood

  • E.g. high levels of exposure to violence

Interventions for childhood disorders

• problem-solving skills training (cognitive)

• behaviour management

• parent management training - PMT

• family based therapy

What does parent management training involve

common strategies to teach parents how to:

• improve the quality of parent-child interaction

• use more effective discipline strategies

Early family/parent training programmes are an effective evidence-based strategy for addressing

behavioural difficulties/disorders

Parent, child, and multicomponent interventions are more effective than

the control conditions

Neurodevelopmental disorders: Attention-deficit hyperactivity disorder (ADHD), Autism spectrum disorder (ASD)

• intellectual development

• communication, e.g. language speech sound

• specific learning

• motor and tic

What is the intellectual development disorder

characterised by deficits in general mental abilities (e.g. reasoning, problem solving, abstract thinking) that impact adaptive functioning (e.g. personal independence, social responsibility)

What is a communication disorder

deficits in the development and use of language, speech, and social communication

• e.g. language or speech sound disorders

What is a specific learning disorder

• characterised by persistent and impairing difficulties with learning foundational academic skills in reading, writing, and/or math

• specific deficits in an individual’s ability to perceive or process information

What is a motor disorder

e.g. developmental coordination disorder, deficits in the acquisition/execution of coordinated motor skills that interferes with daily activities

What is ADHD - Attention-deficit hyperactivity disorder

• Marked restlessness, inattentiveness, and impulsivity – pervasive across situations

• Easily distracted, often forgetful

• Difficulty sustaining attention

• Does not seem to listen when spoken to directly

• Difficulty organising tasks and activities

• Often fidgets with or taps hands/feet

• Often talks excessively, difficulty waiting their turn

• Associated features: behavioural problems, leaning difficulties, relationships/social difficulties

About half the children with ADHD also experience:

• learning or communication problems

• poor school performance

• difficulty interacting with other children

• misbehaviour, often serious

• mood or anxiety problems

What is the average heritability rate of ADHD

76% across 20 studies (Faraone et al., 2005)

Prenatall and perinatal factors ADHD

• maternal smoking

• substance use

• stress

• low weight birth

• prematurity

• dietary factors (e.g. additives)

• toxins (e.g. pesticides, lead)

Childhood factors ADHD

severe early deprivation (e.g. child abuse, neglect)

• potentially affecting individual’s ability to modulate their emotions

What are the changes to the brain in people with ADHD

• changes primarily affecting but not limited to the prefrontal cortex, corpus stratum, and cerebellum

What happens to the brain activity and volume in the prefrontal cortex in people with ADHD

reduced activity and volume

What happens to the neurochemistry in the brain of a person with ADHD

hypoactive dopamine neurotransmission in the frontal lobe leading to poor attention and behavioural organisation, and executive control

• neurochemistry - dopamine, norepinephrine, and serotonin

What leads to closeness and poor habit learning in people with ADHD

low levels of dopamine

In people with ADHD low levels of norepinephrine and serotonin can have an impact on the prefrontal lobe which leads to

difficulty determining what is important in the present environment

Interventions for people with ADHD

• Behaviour modifications – based on principles of learning theory and operant conditioning

• Parenting strategies/training

  • E.g. family problem-solving and communication

• Medication – psychostimulus

• Protective effect of ADHD medication treatment (i.e. reduced risk) on mood disorders, suicidality, criminality, substance use disorders, accidents and injuries, and educational outcomes

• Attentional training programmes

Describe the historical perspective of the Autism spectrum disorder

• 1908-1911:

  • German psychiatrist Bleuler used the term ‘autism’ to describe symptoms of the most severe cases of schizophrenia

• 1943:

  • Kanner publishes a paper describing 11 patients who were focused on or obsessed with objects and had a resistance to (unexpected) change – ‘infantile autism’

• 1944:

  • Asperger, a paediatrician, described a similar group of symptoms and coined the term ‘autistic psychopathy’

• 1950s:

  • Children with symptoms of autism are labelled as having childhood schizophrenia (DSM-||)

• 1970s:

  • Wing proposes the concept of autism spectrum disorders; identifies the ‘triad of impairment’ (social interaction, communication, and imagination)

• 1980s:

  • In the DSM-||| autism was removed from the diagnosis of schizophrenia and implemented as a category within pervasive developmental disorders of childhood

Symptoms of Autism spectrum disorder

• persistent deficits in social communication and social interaction across multiple contexts

• social-emotional reciprocity

  • e.g. failure to participate in a back and forth conversation

• nonverbal communicative behaviours

  • e.g. inappropriate eye contact (too much/too little), difficulty understanding gestures or facial expressions

• developing, maintaining, and understanding relationships

• presence of restricted, receptive patters of behaviour, interests or activities

  • e.g. repetitive motor movements, use of objects, difficulty coping with change/transitions, preference for rigid rules/structure

What is the genetic predisposition of Autism spectrum disorder

• significant heritability estimates of 56% to 95%

• 3,400 8-year-old twin pairs from the general population (TEDS)

  • high heritability found for extreme autistic-like traits (0.64-0.92)

  • autistic-like traits as measured on a continuum (0.78-0.81), with no significant shared environmental influences (Ronald, Happe, Bolton et al., 2006),

What are some of the environmental risk factors in people with ASD

• maternal age (>35)

• maternal hypertension

• maternal obesity before or during pregnancy

• birth complications

Interventions for people with Autism spectrum disorder

• Behaviour-based approaches are the most common interventions: teaching children new behaviours and skills by using structured techniques

• Applied behaviour analysis (e.g. EIBI – early intensive behavioural intervention)

  • behavioural program which involves controlling the child’s environment and reinforcing behaviour of parents

• Positive behaviour support (PBS) – emerged from the ABA; person-centred approach that aims to increase quality of life

• Specialise therapies: speech, occupational, physical

• Community support, parent training, and psychoeducation

What is neurodiversity

all humans vary in terms of our neurocognitive ability

• everyone has a number of strengths and weaknesses

• commonly refers to people with ADHD, ASD, dyslexia, dyspraxia, and other learning difficulties