Child Clinical Psychology - Exam #3

If most children at times exhibit disruptive behaviors, then when should one be concerned with conduct disorder?

When the behavior becomes disruptive, more severe, and persistent over time and leads to the violation of or infringement on the rights of others.

Define conduct disorder.

Age-inappropriate actions and attitudes of a child that violate family expectations, societal norms, and the personal or property rights of others

Identify at least two contributing factors that can lead to increased risk of conduct disorder

Neglect and abuse, substance abuse disorders, and criminal problems in parents of these children

Describe the overall cost to society from youth with conduct disorder.

Costs to the educational, health, social service, criminal justice, and mental health systems that deal with youth make conduct problems one of the most costly mental health problems in North America.

List the four perspectives of conduct problems.

1. Legal - conduct problems are criminal acts

2. Psychological - conduct problems are a continuum of externalizing behavior

3. Psychiatric - conduct problems are a distinct category of mental disorder based on DSM symptoms

4. Public Health - blends all the others with prevention and intervention

List the three dimensions that ODD symptoms can be grouped into.

Negative affect, defiance, and vindictiveness.

Describe Conduct disorder.

Children who display severe aggressive and antisocial acts involving inflicting pain upon others or interfering with the rights of others through physical and verbal aggression, stealing, or committing acts of vandalism.

True/False: Children who display childhood-onset CD have poorer prognoses than those with adolescent-onset CD.

True! Children woth adolescent-onset CD do not display the severity or psychopathology that characterizes the childhood-onset group.

Define callous–unemotional (CU) traits.

This subgroup of kids with conduct roblems lack in guilt, do not show empathy, and do not display feelings or emotions. These children also have a preference for novel and perilous activities and a diminished sensitivity to cues for danger and punishment when seeking rewards.

List the types of deficits in children and adolescents with conduct problems.

Cognitive, verbal, and language deficits

Describe the strongest and most consistent correlate of conduct problems.

General family disturbances, and disturbances in parenting practices and family functioning

Identify at least two risk factors for youths with conduct problems.

Sexually transmitted diseases and substance abuse.

What percent of children with CD also have ADHD?

About 50%

True/False: Youth with CD are more likely to have comorbid depression and/or anxiety.

True! About 50% of children with conduct problems are diagnosed with depression or a co-occurring anxiety disorder

Describe the role of anxiety in conduct problems.

Anxiety related to shyness, inhibition, and fear may protect against conduct problems, whereas anxiety associated with negative emotionality and social avoidance/withdrawal based on a lack of caring about others may increase the child’s risk for conduct problems.

Identify the lifetime prevalence rate for ODD and CD.

ODD is 12%, CD is 8%

Describe the gender difference regarding conduct problems (ODD and CD)

During childhood, conduct problems are about two to four times more common in boys than in girls. This difference narrows greatly in early adolescence, due mainly to a rise in covert nonaggressive antisocial behavior in girls, and then increases again in late adolescence and beyond. Girls are more likely than boys to use indirect forms of relational aggression.

List the forms of relational aggression that girls are more likely to exhibit.

Verbal insults, gossip, or third-party retaliation.

List the two pathways for youth with conduct problems.

1. The life-course–persistent (LCP) path describes youth who display antisocial behavior at an early age and who continue to do so into adulthood.

2. The adolescent-limited (AL) path describes youth whose antisocial behavior begins around puberty and continues into adolescence and who later cease these behaviors in young adulthood.

Describe how much genetic influences account for the variance in antisocial behaviors.

Genetic influences account for about 50% of the variance in antisocial behavior.

Identify the role of the Behavioral Activation System (BAS).

An overactive BAS may contribute to antisocial behavior. Low levels of cortical arousal and autonomic reactivity and deficits in the amygdala, prefrontal cortex, and other brain regions play an important role, particularly for childhood-onset/persistent CD.

List at least three family factors implicated as possible causes of children’s antisocial behavior.

Marital conflict, family isolation, and violence in the home

List at least three treatments for conduct problems.

Parent management training (PMT), Problem-solving skills training (PSST), Multisystemic therapy (MST)

Describe the focus of Parent Management Training (PMT) for conduct problems

Teaching parents to change their child’s behavior in the home.

A developmental pathway to antisocial behavior whereby the child’s antisocial behavior begins around puberty, continues into adolescence, and later desists in young adulthood.

Adolescent-Limited (AL) Path

A specific type of conduct disorder for which individuals show no symptom characteristic of conduct disorder prior to age 10 years.

Adolescent-Onset Conduct Disorder

The premise that stress may serve to amplify the maladaptive predispositions of parents, thereby disrupting family management practices and compromising the parents’ ability to be supportive of their children.

Amplifier Hypothesis

An adult disorder characterized by a pervasive pattern of disregard for, and violation of, the rights of others, as well as engagement in multiple illegal behaviors.

Antisocial Personality Disorder (APD)

A subsystem of the brain that activates behavior in response to cues of reward or nonpunishment.

Behavioral Activation System (BAS)

A subsystem of the brain that produces anxiety and inhibits ongoing behavior in the presence of novel events, innate fear stimuli, and signals of nonreward or punishment.

Behavioral Inhibition System (BIS)

When one or more children expose another child, repeatedly and over time, to negative actions, such as physical contact, words, making faces or dirty gestures, and intentional exclusion from a group.

Bullying

A mode of social interaction that is characterized by an absence of guilt, lack of empathy, uncaring attitudes, shallow or deficient emotional responses, and related traits of narcissism and impulsivity.

Callous and Unemotional (CU) Interpersonal Style

A specific type of conduct disorder whereby the child displays at least one symptom of the disorder prior to age 10 years.

Childhood-Onset Conduct Disorder

A developmental theory proposing that coercive parent-child interactions serve as the training ground for the development of antisocial behavior. Specifically, it is proposed that through a four-step escape-conditioning sequence, the child learns how to use increasingly intense forms of noxious behavior to escape and avoid unwanted parental demands

Coercion Theory

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested in symptoms of aggression toward people and animals, destruction of property, deceitfulness or theft, or serious violations of rules.

Conduct Disorder (CD)

Age-inappropriate actions and attitudes that violate family expectations, societal norms, and the personal or property rights of others.

Conduct Problem(s)

An independent dimension of antisocial behavior consisting of a continuum ranging from acts such as cruelty to animals or destruction of property at one end to nondestructive behaviors such as arguing or irritability at the other.

Destructive–Nondestructive Dimension

A general term used to describe repetitive and persistent patterns of antisocial behavior such as oppositional defiant disorder and conduct disorder.

Disruptive Behavior Disorders

A continuous dimension of behavior that includes a mixture of impulsive, overactive, aggressive, and delinquent acts

Externalizing Behavior

The tendency of aggressive children to attribute negative intent to others, especially when the intentions of another child are unclear (e.g., when a child accidentally bumps into them, they are likely to think the other child did it on purpose).

Hostile Attributional Bias

A broad term used to describe children who have broken a law, anything from sneaking into a movie without a ticket to homicide.

Juvenile Delinquency

A developmental pathway to antisocial behavior in which the child engages in antisocial behavior at an early age and continues to do so into adulthood.

Life-Course–Persistent (LCP) Path

An approach to treatment that attempts to address the multiple determinants of problematic behavior by involving family members, school personnel, peers, juvenile justice staff, and others in the child’s life, and by drawing on multiple techniques such as parent management training, cognitive problem-solving skills training, and marital therapy, as well as specialized interventions such as special education placements, referral to substance abuse treatment programs, or referral to legal services.

Multisystemic Therapy (MST)

A pattern of angry/irritable mood, argumentative/defiant behavior, or vin-dictiveness lasting at least 6 months and exhibited during interaction with a least one individual who is not a sibling.

Oppositional Defiant Disorder (ODD)

An independent dimension consisting of a continuum of antisocial behavior ranging from overt forms such as physical aggression at one end, to covert forms (i.e., hidden or sneaky acts) at the other. The overt forms of antisocial behavior correspond roughly to those on the aggressive subdimension of the externalizing dimension, whereas the covert behaviors correspond roughly to those on the delinquent subdimension of the externalizing dimension.

Overt–Covert Dimension

A program aimed at teaching parents to cope effectively with their child’s difficult behavior and their own reactions to it.

Parent Management Training (PMT)

Instruction aimed at targeting the cognitive deficiencies and distortions displayed by children and adolescents who experience conduct problems in interpersonal situations, particularly those children who are aggressive.

Problem-Solving Skills Training (PSST)

A pattern of deceitful, callous, manipulative, and remorseless behavior.

Psychopathic Features

The theory that the child’s behavior is both influenced by and itself influences the behavior of other family members.

Reciprocal Influence

A form of indirect aggression in which harm is caused through damage to one’s relationships or social status rather than direct physical harm. It may involve the use of verbal insults, gossip, tattling, ostracism, threatening to withdraw one’s friendship, getting even, or third-party retaliation.

Relational Aggression

The skills involved in attending to, interpreting, and responding to social cues.

Social–Cognitive Abilities

The premise that people tend to select environments in which there are other people similar to themselves.

Social Selection Hypothesis

A term used in DSM-5 to describe youths with conduct disorder (CD) who display a persistent and typical pattern of interpersonal and emotional functioning involving at least two of the following three characteristics: lack of remorse or guilt; callous–lack of empathy; and unconcerned about performance.

With Limited Prosocial Emotions

True/False: Mood disorders are common and are among the most persistent and disabling illnesses in young people.

True! Mood disorders are very common, persistent, and disabling for young people

What are the two major types of mood disorders?

Depressive Disorders and Bipolar Disorders (BP)

List the three types of depressive disorders.

Major Depressive Disorder (MDD), Persistent Depressive Disorder (P-DD), (aka dysthymia), and Disruptive Mood Dysregulation Disorder (DMDD)

True/False: The way in which children express and experience depression changes with age.

True! Expression and experiences of depression in children change with age

List the three of the key features of MDD.

Sadness, loss of interest or pleasure in nearly all activities, and irritability

Identify the most frequent accompanying disorders in young people with MDD (5)

1. Anxiety disorders

2. Persistent Depressive Disorder (P-DD)

3. Conduct Problems

4. ADHD

5. Substance-Use Disorder

True/False: Although almost all young people recover from their initial depressive episode, about 70% have another episode within 5 years.

True! Most young people have another depressive episode within 5 years after recovering from one

Describe children with Persistent Depressive Disorder (P-DD)

Children with P-DD display a depressive or irritable mood for most of the day, on most days for at least 1 year. While depressed, they also experience a number of somatic and cognitive symptoms

What percentage of children and adolescents have an episode of P-DD by the end of adolescence

About 5%

List the three of the most common disorders accompanying Persistent Depressive Disorder (P-DD)

Superimposed MDD, Anxiety Disorders, CD, and ADHD

Define Disruptive Mood Dysregulation Disorder (DMDD).

Frequent and severe temper outbursts and chronic, persistently irritable or angry mood.

True/False: DMDD is a new disorder in DSM-5, and it is the one we know the least about.

True! We know little about DMDD 

Describe the reason for the development of the DMDD category.

The development of the DMDD category was a response to increasing rates of bipolar disorder (BP) diagnoses in young children; it was intended to provide an alternative to diagnosing BP in young children too frequently

List the three ways that depression may affect the youth’s cognitive functioning.

Certain symptoms such as difficulty concentrating, loss of interest, and slowness of thought may negatively affect intellectual functioning. They perform more poorly than others in school, score lower on standard achievement tests, and have lower levels of grade attainment.

Identify the three types of thinking distortions in depression.

Negative beliefs, attributions of failure, and self-critical automatic negative thoughts

True/False: Almost all youths with depression experience low or unstable self-esteem.

True! Self-esteem isn’t generally great among youths who have depression

What percentage of youths with depression who think about killing themselves actually attempt it.

About 30%

Describe the psychodynamic theory perspective on depression.

Psychodynamic theories presume that depression results from the actual or symbolic loss of a love object and view depression as the conversion of aggressive instinct into depressive affect.

Describe how attachment theories explain depression.

Attachment theories of depression focus on insecure attachment, a view of the self as unworthy and unloved, and a view of others as threatening or undependable as risk factors for later depression, particularly in the context of stressful interpersonal relationships.

Describe how behaviorism views depression.

Behavioral views of depression emphasize the importance of learning, environmental consequences (particularly a lack of response-contingent reinforcement), and skills deficits during the onset and maintenance of depression.

State the cognitive theory of depression.

Cognitive theories of depression focus on the relation between negative thinking and mood, with the underlying assumption that how young people view themselves and their world will influence their mood and behavior.

Describe what family and twin studies and specific gene studies suggest about depression.

Family and twin studies and specific gene studies suggest that what may be inherited is a vulnerability to depression and anxiety and that certain environmental stressors may be required to express these disorders.

True/False: Youths with depression may experience heightened reactions to stress that decrease their vulnerability to depression.

True! Heightened reactions to stress = decreased vulnerability to depression in youths with depression

Do families of children with depression display more anger and conflict, greater use of control, less effective communication, more overinvolvement, and less warmth and support than families of children who are not depressed?

Yes! Families of children with depression are disorganized in these ways

List at least two ways in which children of depressed parents are affected.

Increased rates of depression before puberty and higher rates of phobias

State the two depression treatments that have the most evidence.

Cognitive–behavioral therapy and interpersonal psychotherapy

True/False: SSRIs have been recommended as the first line of drug treatment for children with depression.

Yes! SSRIs are the premier first choice for children with depression

True/False: Bipolar disorder (BP) diagnosis in children and adolescents is controversial.

Yes! BP diagnosis in children is quite controversial 

Identify the primary core feature of BP in youth.

Periods of abnormally and persistently elevated, expansive, and/or irritable mood

List at least two symptoms of BP.

Inflated self-esteem and decreased need for sleep

Identify at least three common accompanying disorders of BP.

ADHD, anxiety disorders, and conduct problems

A negative mood state characterized by a lack of enjoyment in anything one does and a loss of interest in nearly all activities.

Anhedonia

A type of mood disorder characterized by an ongoing combination of extreme highs and extreme lows. An episode of mania is an abnormally elevated or expansive mood, and feelings of euphoria are an exaggerated sense of well-being. The highs may alternate with lows, or both extremes may be felt at about the same time.

Bipolar Disorder (BP)

A negative form of self-disclosure and discussion between peers focused narrowly on problems or emotions to the exclusion of other activities or dialogue.

Co-Rumination

A style of thinking displayed by depressed individuals; it is characterized by a narrow and passive focus on negative events for long periods of time.

Depressive Ruminative Style

The negative perceptual and attributional styles and beliefs associated with depressive symptoms.

Depressogenic Cognitions

A theory of depression proposing that the impact of stress is moderated by individual risk factors and that the occurrence of depression depends on the interaction between the subject’s personal vulnerability and life stress.

Diathesis–Stress Model of Depression

A DSM-5 depressive disorder characterized by: (1) frequent and severe temper outbursts that are extreme over-reactions to the situation or provocation; and (2) chronic, persistently irritable or angry mood that is present between the severe temper outbursts.

Disruptive Mood Dysregulation Disorder (DMDD)

An instance in which a major depressive episode is superimposed on the individual’s previous persistent depressive disorder, causing the individual to present with both disorders.

Double Depression

A negative mood state characterized by prolonged bouts of sadness.

Dysphoria

A depressive disorder associated with depressed or irritable mood; generally fewer, less severe, but longer-lasting symptoms (a year or more in children) than seen in major depressive disorder (MDD); and significant impairment in functioning.

Dysthymia

The processes by which emotional arousal is redirected, controlled, or modified to facilitate adaptive functioning.

Emotion Regulation

An exaggerated sense of well-being.

Euphoria

The view that depression-prone individuals make internal, stable, and global attributions to explain the causes of negative events and external, unstable, and specific attributions about positive events. This attributional style results in the individual taking personal blame for negative events in his or her life and leads to helplessness, avoidance, and hopelessness about the future, which promotes further depression.

Hopelessness Theory

A common symptom of major depressive disorder and disruptive mood dysregulation disorder characterized by easy annoyance and touchiness, an angry mood, and temper outbursts.

Irritability

A form of depressive disorder characterized by five or more mood, cognitive (e.g., indecisiveness, inability to think or concentrate), psychomotor (e.g., agitation or retardation), or somatic (e.g., weight loss, sleep disturbances) symptoms that have been present during the same 2-week period; at least one of the symptoms is either depressed mood most of the day, nearly every day, or markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

Major Depressive Disorder (MDD)

An abnormally elevated or expansive mood.

Mania