childhood disorders

What is developmental psychopathology?

The origins and development course of individual maladaptation in the context of typical growth processes.

What are the most common mental health problems in children?

Anxiety and irrational fears, depression, ADHD, and aggression or rule violation.

Is ADHD a mental health disorder?

Not technically, but it does often result in mental health problems.

What is the point prevalence of clinically significant mental health issues in children 4-17 years old?

15%, but this is likely an underestimate.

Why is the point prevalence of clinically significant mental health issues in children 4-17 years old likely an underestimate?

Because many children don’t meet diagnostic criteria, many children will choose to not disclose their mental health problems because of self-preservation concerns, and we will see many children committing suicide “out of nowhere”.

Are mental health disorders comorbid in children?

Yes, roughly 50% of children have a comorbid mental health disorder, meaning they have more than one disorder at a time.

What percept of children actually get treatment?

less than 25%.

Why do so few children get treatment?

Because treatment wait times are very long and it is very expensive.

What is the median age of onset of anxiety?

6.

What is the median age of onset of behavioural problems?

11

What is the median age of onset of mood disorders?

13

What is the median age of onset of substance abuse?

15

What are major issues regarding treatment of childhood disorders?

Children can’t seek treatment for themselves, meaning they don’t great treatment quickly or even at all. There is a need to treat the parents/family. Parents/family can often counteract treatment and make things worse.

What is the primary biological difference between children and adults?

Incomplete development of the PFC.

What are the results of incomplete development of the PFC?

Difficulty engaging in executive function and impulse control.

How are the PFC and amygdala related?

An undeveloped PFC leaves the amygdala unchecked, resulting in aggression, fear, and lack of impulse control.

What is synaptic pruning?

The deterioration of brain areas that are not activated.

Why is synaptic pruning an etiology for childhood disorders?

Because it results in what you practice being what you keep, including early responses to conflict or high stress becoming automatic cognitions. However, these can be consciously overruled with practice.

What are the primary psychological etiologies for childhood disorders?

Lack of experience, theory of mind (everyone has the same thoughts as you), self and the cause of others behaviour, simplistic view of the self/world, and immediate threats being very important.

What are the primary psychological treatments for childhood disorders?

CBT, IPT, Psychodynamic therapy, and play therapy.

What are the social etiological factors that contribute to the development of childhood disorders?

Dependence on others, lack of control over the environment, level of stress in the environment, and maltreatment.

How is maltreatment related to childhood disorders?

Maltreatment is causally related to the development of childhood disorders, however many cases of maltreatment go unrecognized or are not looked into thoroughly.

What are the common social treatments for childhood disorders?

IPT and family systems therapy.

What are the two types of internalizing disorders?

Anxiety and depression.

What comes first, anxiety or depression?

In children, often anxiety comes first which then results in depression.

Are anxiety and depression comorbid with eachother?

Highly.

What typically triggers anxiety in children?

Threat or risk.

What typically triggers depression in children?

Loss, or high and chronic stress.

What percent of children aged 5-17 have anxiety?

6%

Is there a sex different in anxiety prevalence?

Yes, there is a 2:1 ration of girls to boys who develop anxiety.

Is anxiety comorbid with other disorders?

Yes, it is especially comorbid with other types of anxiety and depression.

What are the primary biological etiologies that contribute to the development of childhood anxiety?

Temperament in childhood, differences in autonomic reactivity (sympathetic nervous system), and personality differences with some kids just being more easily conditioned to anxiety.

How is temperament in childhood a risk factor for anxiety?

At 6 months old, if a kid is easily overstimulated it is likely they will be more shy and have a higher risk of anxiety. Whereas if a kid is not easily overstimulated they will likely me more sociable and have a lower risk of anxiety.

What are psychological risk factors for the development of childhood anxiety?

The tendency to avoid novel and unfamiliar situations.

What social risk factors contribute to the development of childhood anxiety?

Have a family environment that increases anxiety and decreases adaptive coping skills, a parent being an anxiety sensitizer vs. suppressor, or a unusually high level of stress or threat exposure.

What does it mean for a parent to be an anxiety sensitizer vs. suppressor?

An anxiety sensitizer gives attention but does not teach any coping mechanisms, while a suppressor gives attention but also teaches the child how to cope with the stressor in the future.

What is the typical biological treatment for childhood anxiety?

SSRI’s, but they must be combined with CBT.

What are the typical psychological treatments for childhood anxiety?

Behavioural therapy focusing on exposure, and CBT focussing on problem solving.

What is the STEPS framework?

A method of approaching childhood anxiety commonly used in CBT.

1. What is the Situation?

2. Think of possible solutions.

3. Evaluate the solutions.

4. Pick one and try it.

5. See if it worked and reevaluate if not.

What types of social therapy are often used to treat childhood anxiety?

Parent/family treatment, which when combined with CBT makes treatment 2x more effective. An example of this is parent-child interaction therapy.

What is parent-child interaction therapy?

When a clinician observes a parent and child interacting and tells the parent, though an earpiece, how they should react to their child’s behaviour.

How is childhood depression different from adult depression?

Childhood depression usually presents are more irritability and less sadness.

What percent of children have depression in preschool, grade school, and adolescence?

1% of preschool aged children, 2-4% of grade school aged childre, and 8-15% of adolescents have depression.

Are there any sex differences in the prevalence of childhood depression?

In young childhood there are no noticeable sex differences but in adolescents there is a 2:1 ratio of girls to boys who have depression?

Why are girls more likely to have depression in adolescence?

Likely due to relational aggression.

How long does the average major depressive episode last?

7-9 months.

What percent of patients recover from childhood depression after 2 years?

90%

Where does suicide rank in terms of leading causes of death both for children aged 5-14 and children aged 12-17.

For children aged 5014, suicide is the 5th leading cause of death. For children aged 12-17, suicide is the 2nd leading cause of death.

What psychosocial risk factors increase the likelihood of developing childhood depression.

Perfectionism, others same as adults

What is the best biological treatment for childhood depression?

SSRI’s

How does childhood depression usually present in adolescents?

Formal operations, hopelessness, hypersomnia, and weight changes.

How does childhood depression present in children?

Somatic complains, psychomotor retardation, greater overlap with anxiety.

What are examples of formal operations that depressed adolescents often make?

Abstract and complex thoughts (life is meaningless), egocentrism (not one understands), cognitive inflexibility (nothing will ever change), and metacognition (i’m just a depressed person).

What are typical psychological treatments for childhood depression?

CBT and behavioural activation.

What social factors can contribute to the development of childhood depression?

Having a depressed parent, critical parents, and other similar social factors as adults.

What social treatment is often used to treat childhood depression?

IPT.

What is ADHD?

A chronic neurological disorder.

What are the three primary subtypes of ADHD?

Inattentive, hyperactive-impulsive, and combination.

What are the DSM symptoms of ADHD?

Hyperactivity, forgetfulness, poor impulse control, distractibility, and “run by a motor”.

How did Russell Barkley operationalize ADHD?

He believed it was a disorder of self-regulation and executive function, with its primary symptoms actually being issues in performance (not skill), low response inhibition, time-blindness, periods of hyper-focus, and difficulty with transitions.

What is the prevalence of ADHD?

Roughly 1-7% of the population, but rates are increasing substantially.

How often does ADHD persist into adulthood?

60% of the time, but symptoms will usually change.

Are there sex differences in ADHD?

Yes, ADHD affects roughly 4:1 boys to girls, but this is probably incorrect it’s just that boys exhibit more outward symptoms so they get diagnosed more.

Is ADHD genetic?

Yes, roughly 30% of people with ADHD have a family member with the disorder?

What biological factors increase someones risk of developing ADHD?

Having a family member with ADHD, low dopamine (linked to sensation seeking), and pre-perinatal stress including cocaine use or birth complications.

What social factors increase the risk of someone developing ADHD?

Family adversity and disorganization, likely due to the presence of another family member with ADHD.

How is DA related to ADHD?

Individuals with ADHD tend to have low DA, causing them to do more impulsive/hyperactive things to seek out more DA.

How are the PFC and amygdala related to ADHD?

There is a poor connection between the amygdala and PFC in people with ADHD< which affects impulse control.

What is the underarousal theory of ADHD?

The idea that people with ADHD lack dopamine so they do more things to get a dopamine high. This is linked to sensation seeking.

Biologically, why do people with ADHD often exhibit inconsistent attention?

Because important brain structures, such as the striatum, frontal lobes, and posterior periventricular region, are not filtering out distractions.

How does behavioural inhibition relate to ADHD?

Most people with ADHD have an underactive behavioural inhibition system, leading them to not be as worried about fear or punishment and be less motivated.

How do brain “gates” relate to ADHD?

Many people with ADHD have underfunctioning gates that are unable to filter out distracting stimuli. This results in the sensory cortices being flooded with incoming messages leading to high blood flow (specifically sensitive to vision and sound input areas)

What are the biological presentations of ADHD?

Low DA, poor PFC and amygdala connection, underactive behavioural inhibition system, inconsistent attention.

What is the most effect way to treat ADHD?

Through medications like Methylphenidates (Ritalin or Concerta)

How does ADHD medication work?

Methylphenidates work to reduce blood flow in the brain, which increases the function of the striatum, frontal lobes, and posterior periventricular region. This all works to increase the availability of DA. The result of the process is increased focus, inhibitory control, and regulation of extraneous motor behaviour.

What percent of school aged children does ADHD medication work for?

60-80%

What psychological treatments are used to treat ADHD?

Cognitive therapy, working to externalize executive functioning. Behavioural therapy focusing on reward systems and frequent breaks. Environment adjustments and accommodation.

What social treatments are used to treat ADHD?

Environmental adjustments and accommodations are necessary. Behavioural parent training emphasizing time-limited attention, emotion regulation, and rule following.

What is conduct disorder?

Conduct disorder is typically describe as a violation of rules and a disregard for the basic rights of others.

What are the typical symptoms of conduct disorder?

Aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules, and often lack of remorse.

What other disorders are comorbid with conduct disorder?

ADHD, substance abuse, anxiety, and depression.

What percent of children aged 4-16 have conduct disorder?

8% of boys and 3% of girls.

How does conduct disorder present differently in childhood vs. adolescence?

In childhood conduct disorder presents more often in boys and is life-course persistent. In adolescence, it presents equally in boys and girls and usually dissipates in young adulthood.

How does antisocial behaviour relate to conduct disorder?

Antisocial behaviour has a 50% heritability and it a likely contributing factor to the development of conduct disorder.

How does the MAOA gene relate to conduct disorder?

Low MAOA, which is responsive for breaking down 5-HT, NE, and DA, will lead to increased aggression.

What is the difference between passive and active gene-environment correlations?

Passive gene-environment correlations are when the parents create the environment for the genes to express themselves. Active gene-environment correlations are when the kids create the environment for the genes to express themselves.

What common symptoms of conduct disorder are usually inherited?

Antisocial behaviour, callous-unemotional style, executive dysfunction (including poor problem-solving and planning), high emotional reactivity, and sensation seeking.

What psychological risk factors contribute to the development of conduct disorder?

Empathy and perspective taking deficits and hostile attribution bias.

What is hostile attribution bias?

The belief that when someone hurts you they were out to get you.

What social factors contribute to the development of conduct disorder?

Modeling by parents, inter-parent discord (fighting), overly harsh discipline, inconsistent reward/punishment, low parent involvement or weak bonding, and differential attending/reward processes.

What biological treatments are used for conduct disorder?

Antipsychotics and sometimes stimulant medication.

What social treatments are used for conduct disorder?

Parent management training focusing on relationship-building, attending and active ignoring, effective instructions, praise/reward system, and consequences. Multisystem treatment is also used instead of incarceration.

Why is harsh discipline not an effective way to manage conduct disorder?

Because it negatively reinforces the behaviour with attention and often leads to increases in delinquency.

What is multisystemic treatment?

A form of treatment for conduct disorder that involves the child, family, school, peer groups, and the community to work together to find the fit between the problem and the systemic context. It requires daily/weekly effort from the family and community and is only only used instead of incarceration.