Childhood Disorder Exam 2

Onset Course Duration outcome and treatment of Autism Spectrum Disorder

• Onset: symptoms often recognized at 12-24 months, average age of diagnosis 5.5 years 

• Course: chronic and/or worsening 

• Duration: life long

• outcome: dependent upon level of impairment 

• Treatment: Intensive treatments can be extremely effective, uses ABA (applied behavioral analysis), needs to be for a lot of hours

Key Symptoms of ASD

• A: deficits in social communication and social interaction manifested by deficits in ALL: 

  • social emotional reciprocity 

  • nonverbal communication 

  • developing, maintaining, and understanding social relationships 

• B: Restricted, repetitive patterns of behavior interests, or activities manifested by two of the following:

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

  • insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal and nonverbal behavior

  • highly restricted, fixated interests that are abnormal in intensity or focus 

  • Hyper- or hypoactivity to sensory input or unusual interest in sensory aspects of the environment

• C: symptoms must be present in early developmental period 

• D: symptoms cause clinically significant impairment in social, occupational, or other important areas of functioning

• E: not better explained by Intellectual Disability or Global Developmental Delay

Onset, course, duration, outcome and treatment of Specific learning disability

• onset: during school age 

• course: chronic 

• duration : learning problems often persist into adulthood, particularly if they are not targeted for treatment in early elementary school 

• outcome: If untreated, these deficits persist over time 

• treatments: Use different interventions depending on problem area, basic reading treatment, guided oral reading, for example

Key Symptoms of Specific Learning Disability

• A: difficulties learning and using academic skills that has persisted for 6 months

• B: affected academic skills are below those expected for the individuals chronological age, and cause significant interference with academic performance or daily living confirmed by individually administered standardized achievement measures and clinical assessment

• C: begins during school-age,

• D: Learning difficulties are not better accounted for by intellectual disability or other problems 

  • Problems with reading, writing, or math 

Onset, course, duration, outcome, and treatments of ADHD

• onset: must be before age 12, often see symptoms earlier 

• Course: Chronic

• Duration: symptoms decrease, particularly hyperactive-impulsive, but impairment does still stay

• outcome

• Treatment:

  • Behavioral treatments: Parent training, classroom management, social skills training 

    • uses ABC model to change behavior based on operant/social learning theory principles 

  • Psychostimulants/nonstimulant medication 

  • cognitive training 

  • Combination of behavior and medication recommended for school-aged children

Key Symptoms of ADHD

• developmentally inappropriate levels 

• duration of 6 months 

• cross-setting Occurrence of Symptoms 

• Impairment in major life activities 

• onset of symptoms/impairment by 12 

• Inattention symptoms (need 6 of 9 in kids) 

  • fails to give close attention to details 

  • difficulty sustaining attention 

  • does not seem to listen when spoken to 

  • does not follow through on instructions 

  • difficulty organizing tasks or activities 

  • avoids tasks requiring sustained mental effort 

  • loses things necessary for tasks 

  • easily distracted 

  • forgetful in daily activities  

• Hyperactive-Impulsive (6 of 9) 

  • Fidgets with hand or feet or squirms in seat 

  • leaves seat in inappropriately 

  • runs about or climbs excessively

  • has difficulty playing quietly 

  • is “on the go” or “driven by a motor” 

  • talks excessively 

  • blurts out answers before questions are completed 

  • has difficulty awaiting turn 

  • interrupts or intrudes on others 

Onset, course, treatments of ODD

• onset: first symptoms can appear during preschool, but can see emergence through adolescence, if it’s a childhood-onset it’s more likely to turn into conduct disorder 

• Course: worsening symptoms with improvement after adolescence, unless conduct disorder develops 

• Treatment:

  • parent management training

  • problem solving skills

  • Multisystemic therapy (family, school environment, friendships, neighborhood)

Key symptoms of ODD

• A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months,  needs at least 4 exhibited with an individual who is not a sibling 

  • Angry/irritable mood

  • Argumentative/Defiant behavior 

  • vindictiveness 

• Behavior must be developmentally inappropriate 

  • children under 5 - behavior should occur on most days for 6 months

  • children over 5 - behavior occurs at least once a week for 6 months

• Distress or functional impairment 

• Do no occur exclusively during the course of a psychotic, substance use, depressive or bipolar disorder 

onset, course, outcome, and treatments of CD

• onset: can be in childhood or adolescence 

• Course: depends on onset

  • Adolescent: might “grow out of it”

  • Childhood w/out CU/LPE: worsens over time

  • Childhood w/ CU/LPE: might later be diagnosed with APD, poor response to treatment

• outcome: depends on onset

  • Adolescent: better response to treatment 

  • Childhood w/out CU/LPE:  moderate response to treatment 

  • Childhood w/ CU/LPE: might later be diagnosed with APD, poor response to treatment

• Treatment:

  • parent management training

  • problem solving skills

  • Multisystemic therapy (family, school environment, friendships, neighborhood)

Key symptoms of CD

• patterns of behavior where the basic rights of others or major age-appropriate societal norms or rules are violated 

• needs 3 or more of the following criteria in the past 12 months, at least 1 criterion present in the past 6 months 

• Aggression to people and animals

• Destruction of property 

• Deceitfulness or Theft 

• Serious violation of rules 

• specific types: Childhood-onset type, adolescent-onset type, unspecified onset (not enough info on when first symptom began) 

• Subtype: limited prosocial emotions/Callous unemotional traits 

3 broad areas where children can show impairments in specific learning disability

• Reading: word reading accuracy, reading rate of fluency, reading comprehension 

• Writing: Spelling accuracy, grammar and punctuation accuracy, clarity or organization of written expression

• Mathematics: number sense, memorization of arithmetic facts, accurate fluency calculation, accurate math reasoning

ASD symptoms and impairments

• Social communication/interaction impairments 

  • lack of social-emotional reciprocity, deficits in social relationships, deficits in nonverbal communication 

• Restrictive, repetitive patterns of behavior 

• impairments in social, occupational or other important areas of current functioning 

Self- Injurious behaviors, definition, theories for cause, and treatments

• Repetitive movements of the hans, limbs, or head in a manner that can, or does, cause physical harm or damage to the person 

  • communication 

  • endogenous opioid release

• Reinforcement/ extinction 

  • differential reinforcement of other behavior (DRO)

    • Has to be consistent 

    • Is environment specific 

  • Noncontingent reinforcement (NCR) 

• Can’t stop reinforcing self-injuries altogether because they’ll intensify to try and get a (extinction burst). Have to reward not doing the self-injurious behavior (DRO) 

Best and worst outcomes for ASD

• Dependent on level of impairment 

• Better prognosis with higher IQ (>70), better verbal skills, and early intervention  

  • Less severe autism symptoms, improved educational outcomes, increased likelihood of functioning within normal limits in later in life 

• Poor prognosis for IQ<50 or no communicative language by age 5-6

2 hypothesis (with evidence) for increase in ASD diagnoses

• Increased awareness (parents and physicians) 

• ID turns into ASD diagnosis

When to use harsh punishments

• there is an immediate physical danger to the individual or to others

• the scientific literature suggests the restrictive procedure would be effective 

• less restrictive intervention would be ineffective or harmful 

• the restrictive treatment is discontinued when its benefits can be maintained through a less restrictive means 

• the treatment is reviewed and approved by a peer and human rights committee, and the individual’s guardian provides consent  

ADHD diagnostic criteria and presentations

• two symptom types, Hyperactivity-Impulsivity and Inattention, 3 presentations, Hyperactive-impulsive subtype, combined subtype, inattentive subtype 

• developmentally inappropriate levels 

• duration of 6 months 

• cross-setting Occurrence of Symptoms 

• Impairment in major life activities 

• onset of symptoms/impairment by 12 

• Inattention symptoms (need 6 of 9 in kids) 

  • fails to give close attention to details 

  • difficulty sustaining attention 

  • does not seem to listen when spoken to 

  • does not follow through on instructions 

  • difficulty organizing tasks or activities 

  • avoids tasks requiring sustained mental effort 

  • loses things necessary for tasks 

  • easily distracted 

  • forgetful in daily activities  

• Hyperactive-Impulsive (6 of 9) 

  • Fidgets with hand or feet or squirms in seat 

  • leaves seat in inappropriately 

  • runs about or climbs excessively

  • has difficulty playing quietly 

  • is “on the go” or “driven by a motor” 

  • talks excessively 

  • blurts out answers before questions are completed 

  • has difficulty awaiting turn 

  • interrupts or intrudes on others 

validity concerns of ADHD presentations

• Are presentation distinctions warranted?

  • largely do not differ on core neuropsychological and neurobiological variables and share common genetic risk factors 

• Is hyperactive/impulsive subtype real? 

• Is the diagnostic paradigm developmentally appropriate? 

• Is there a separate disorder for some of the children diagnosed with ADHD inattentive type? 

• Gender differences real? 

Sluggish cognitive tempo/ cognitive disengagement syndrome

• Symptoms: 

  • daydreaming/spacey/stares

  • slow information processing

  • hypoactive/lethargic/sluggish 

  • Easily confused, mentally “foggy” 

  • poor focused/ selective attention 

  • erratic retrieval - Long-term memory 

  • socially reticent/uninvolved 

• Rarely comorbid of ODD/CD

• less likely to respond to psychostimulants 

• more likely to evince perceptual or motor control deficits 

• Possibly greater family history of anxiety disorders and LD (?)

Executive functions and working memory

• executive functions: a person’s capacity to effectively  perceive, process, and use information in order to sole problems and attain long-term goals (RE-WATCH VIDEO)

  • planning, organization, prioritizing, initiating tasks 

  • Self-monitoring, self-inhibition

  • shifting attention 

  • working memory: a cognitive system with a limited capacity that can hold information temporarily  

how do we know that executive functions are implicated in ADHD

• Children with ADHD exhibit an under-aroused prefrontal cortex 

• AND a structurally underdeveloped brain 

is movement functional in ADHD

• yes movement is functional for children with ADHD 

• Study shows that children with ADHD perform better on a working memory task when they move more 

• Children without ADHD performed worse the more they moved

Behavioral treatments: how they are theorized to work, evidence

• Based on operant/social learning theory principles (uses ABC model to change behavior)

  • Parent training: parents are taught skills to help with poor attention, organization, compliance, independence, emotional regulation. Focus on positive strategies. Skills include: praise, rewards, using effective instructions, scaffolding peer interactions, prompting for emotional regulation skills, selective attention/planned ignoring, removing privileges, contingency management programs

    Also uses classroom training and child skills training

• behavioral alone has moderate benefits

• best for impairments like social skills, organizational functioning, emotion regulation, compliance

stimulant medications: how they are theorized to work, evidence

• Psychostimulants such as methylphenidate (MPH)

  • dopamine and norepinephrine reuptake inhibitors 

  • promote availability of dopamine in PFC and other areas 

• most effective when combined with behavioral interventions

cognitive training: how they are theorized to work, evidence

• based on concept of neuroplasticity: repeated practice or use can “rewire” the brain

• mainly commercially available programs 

• all effects were duet to placebo effect, with significant variability among studies 

ABC model

• Antecedent 

• Behavior 

• Consequence 

• Uses this in therapy to set up child with ADHD for success 

Coercive parenting cycle and patterson’s model

• coercion: persuading someone to do something by using force or threats 

• parent derides, demeans, or diminishes children and teens by continually putting them in their place, putting them down, mocking them, or holding power over them va punitive or psychologically controlling means 

• results in coercive parent-child cycle: negative reinforcement teaches parent and child ways to act 

• Think about the cycle image in slides

Know how the etiology, symptom presentation, and response treatment for Adolescent-onset CD

• etiology: exaggeration of normal autonomy-seeking processes of adolescence 

  • relative to TD teens, more rebelliousness and rejection of conventional values 

  • influence by peer groups, poor parental supervision, not associated with hostile parenting 

• Symptom presentation: less aggression, less criminality/antisocial behavior in adulthood, fewer dispositional risk factors (CU, emotional dysregulation, impulsivity) 

• Response to treatment : good 

Know how the etiology, symptom presentation, and response treatment for child-onset CD without CU

• Etiology: hostile, coercive parenting

  • emotional dysregulation

  • diathesis (fearlessness, impulsivity) Stress (poor parental supervision, low parental warmth, coercive parenting) 

• symptom presentation and course: symptoms appear early in childhood, worsen

  • antisocial and criminal behavior in adulthood 

  • increased aggression (reactive/impulsive rather than provocative) 

  • more mood symptoms, emotional dysregulation, emotional reactivity 

  • high anxiety, distressed by own behavior, appropriate empathic reaction 

• response to treatment: moderate

Know how the etiology, symptom presentation, and response treatment for Child-onset CD With CU

• Etiology: highly heritable (genes for serotonin and oxytocin systems implicated)

  • warm parenting style and appropriate parental involvement may be protective, but studies are inconsistent 

• Symptom presentation and course

  • lack of concern about own behavior, poor empathic skills 

  • constrained display of emotions; emotional hyporeactivity 

  • low effort, more severe conduct problems, more aggressive, stable sx

  • highest rates of APD in adulthood 

• Response to treatment: poor, some say worsening symptoms 

  • less susceptible to punishment techniques due to low emotional response to sanctions 

Callous unemotional traits/limited prosocial emotions; implications for etiology and treatment

• they predict: violent sexual offenses 

  • adult measures of psychopathy at ages 18-19, even after controlling for early CD problems and other risk factors 

  • more severe CD problems, violence, aggression, & delinquency: a more seer and stable pattern of antisocial behavior

• CU traits are usually stable into early adulthood 

• Thoughts to be a precursor to psychopathy traits in adulthood

ADHD vs SLD

SLD: associated psychological correlates: setting - SLD not impaired outside of academic setting

ADHD vs ASD

constellation of symptoms

• Overlap in inattention and social dysfunction, but different quality

ADHD vs ODD

• Forgetfulness vs defiance 

• ADHD Dx- only is refusal is solely in situations that demand sustained effort and attention or demand that the individual sit still 

ODD vs CD

• can meet criteria for BOTH ODD and CD

• aggression, antisocial behavior, violating others’ rights = CD

• Emotional dysregulation in ODD, not CD 

treatments for ODD/CD (at least 3)

Parent management training

• uses techniques like using token economies, practicing time out, and a daily school behavior report card

Problem solving skills training

• skills like feeling recognition and anger management

Multisystemic therapy (MST)

• targets the many “systems” that impact youth: Family, school environment, friendships, neighborhood

• Works closely with the parents and child for 3-5 months in their home and community

All treatments dependent on severity of problems