Psych131 Unit 2

What are substance use problems comorbid with

- covert ASB - later onset

- conduct problems/ADHD - early onset

how does the DSM iV describe substance abuse vs substance dependence

- abuse: patterns of use leading to various problems and continued use despite interpersonal consequences — You continue to use high amounts even though theres bad consequences. Lost income, lost job, etc.

- dependence: use leads to physical problems, inability to cut down, or major consequences —- Now because of your use of substances, if you try to slow down or stop, you’re a wreck physically and mentally (tolerance withdrawal). Become physically dependent on substance

how does the DSM-5 describe substance abuse and dependence?

- combines substance abuse and dependence into "substance use" disorders

- severity ranges on a continuum: mild, moderate, severe

what is tolerance in substance use

- when more of a substance is needed to achieve the same physiological effect

what is the metabolic aspect of tolerence

the substance enhances the enzymes that degrade the substance, so that more is needed to yield the same effect

what is the cellular aspect of substance use

- the substance alters brain physiology and chemistry

- downregulation... fewer receptors... need more to get the same 'high.'

what is withdrawal/abstinence syndrome?

- if you stop or even cut down on using the substance, a characteristic physiological syndrome results

- generally, the opposite effects of the drug itself

what are stimulants (SDRIs: dopamine agonsits)

- enhance attention, focus; keep you awake; enhance motivation/pleasure

- intense high at certain doses

- note: lack of these effects in individuals with ADHD

what are opioids

- pain reduction, somnulence, euphoria

- opioid receptors/endorphins

what are sedatives/hypnotics

- GABA agonists

- anxiety reduction, sleep enhancement

what is THC

- THC receptors - called cannabinoid system 

• cognitive disorganizers

- physiological effects not as definitive as other substances

what is the unifying model of adiction

- after a few synapses, dopamine neurons and tracts are "engaged."

- Substances "hijack" our anticipated reward system and lead to feelings of pleasure without the preceding "work."

- leads to huge motivation to keep using

Regular use of ____ before age 16 predicts decrement in IQ scores

THC

biological vs. psychosocial models of the negative effects of early THC/drug use

- biological/developmental: Are drug circuit systems particularly vulnerable to early/adolescent use?

- psychosocial: do early starters get diverted from productive academic and social pathways?

[DP perspectives] what are the age, family, & peer factors of addiction

• Age

  • Early age of use onset highly predictive of serious later problems

    • If you don’t start using until 20-30s, then you aren’t as prone to addition, but any earlier → more addiction rate 

• Family and Peer factors

  • Low parenting monitoring

  • Association with substance using peers: casual influence

• Gene environment interaction 

what are the biological/genetic factors of addiciton

- higher heritabilities for early onset forms

- "inborn" tolerance highly predictive of serious alcoholism

_____ gene AND use of marijuana before age 15 as potential risk factors predicting young adult _______ behaviors

COMT, psychotic

How can aggression be interpreted through sociology, anthropology, and biology?

- sociology: what are social standards against which to define aggression

- anthropology: is aggression part of the species, given territoriality, selfishness, etc?

- biology: when is aggression normative--or adaptive? when is it pathological

What is the psychiatric classification of Oppositional Defiant Disorder (ODD)

- persistent pattern of negative, oppositional, defiant behavior

- at extremes, quite impairing for a child, family, school

developmental question: is it a predictor of later, serious ASB

What is the psychiatric classification of Conduct disorder (CD)

- serious pattern of assault, rule violations, and/or covert ASB

- hard to diagnose before late childhood because of the severity of problems

- blend of overt and covert problems: either or both

how many children progress from ODD to CD

- 30-40%

- ODD could be used as an early warning system

what are the correlates and outcomes of ODD and CD

- poor school achievement (ADHD more causal factor)

- social-cognitive deficits: processing social info as threat

- peer rejection, controversial ratings

- authoritarian AND permissive parenting (coercion)

- low SES (proximal factor? parenting/unsafe neighborhood)

despite being relatively rare (<5% of boys, <1% of girls), ____/___ may account for 50% of crime

ODD/CD

What is the serious childhood externalizing behavior associated with ODD

- disorganized attachment

- poor EF

- negative parenting

- peer rejection

What is the "maturity gap" of aggression in adolescents

earlier puberty -> delayed access to social goods -> antisocial peers

what is ASB heritability

~0.5 for overt ASB but ~0.3 for covert ASB

What are the rates of ASB externalizing behavior for boys vs girls

- differences in temperament small before 3 years old, then boys rise quickly (low effortful control)

- girls increase covert ASB in early adolescence, but almost never as violent as boys

African American and Latinx individuals have higher rates of ASB, but these vanish when ___ is included

SES

What is the biggest risk factor of early-onset ASB

- young age of mother is most predictive (a proxy for a whole lot of other risk factors)

What does the large amount of risk factors suggest about ASB

- We should look at reciprocal and transactional models

- e.g. coercive parenting in a context of a difficult childhood, stressed family, and dangerous neighborhood, with deviant peer models

what are risk factor combinations resulting in the highest levels of ASB

- low verbal IQ and family adversity

- birth complications and early rejection

- early puberty and being a girl in a coed school

_____ are more likely to display relational forms of aggression

girls

what are the ratios of early onset and adolescent onset for boys vs girls

- early onset = 7:1, boys:girls

- adolescent onset = 1:1

more than boys, girls with conduct problems have a high risk for what

depression, suicidality, low-quality relationships, somatization

what is MST

- multisystemic therapy

- on-call therapist meets constantly with the child

- cuts suicidality by 40% for ASB

what meds are used to treat ASB

- meds are not very effective

- meds are mostly used to treat related disorders (e.g. stimulants for ADHD or mood stabilizers for bipolar disorder)

how is ADHD defined in the DSM 4 and 5

- 9 symptoms of inattention

- 9 symptoms of hyperactivity/impulsivity

- must yield impairment in 2+ settings

ADHD is a _____ not a disorder

- syndrome

Why might the US and Israel have the highest rates of ADHD anywhere

high productivity, high achievement cultures

Which disorders are most comorbid with ADHD

- ODD: 30-50%

- CD: 10-20%

- Anxiety disorders: >30%

- depression: 20%

Why is an ADHD diagnosis controversial in baseball?

- ADHD diagnosis is much more common in baseball than in other sports

- allows players to medicate (use stimulants)

- Does baseball attract ADHD individuals, or is it an excuse for performance-enhancing drugs?

What are the 3 presentations of ADHD

- combined:

• trouble paying attention (inattention)

• lots of energy / impulsive behavior (hyperactive-impulsive, often shortened to H/I)

• 👉 Example: someone who is easily distracted and also fidgets, interrupts, or acts without thinking.

- inattentive: high on inattention only. most common

• You mainly have attention problems, but not much hyperactivity.

• 👉 Example: someone who:

  • daydreams a lot

  • forgets things

  • has trouble focusing or finishing tasks

• They may seem “quiet” or “spacey” rather than hyper.

- hyperactive-impulsive: high on HI dimensions only

• You mainly have high energy and impulsive behavior, but attention may be okay.

• 👉 Example: someone who:

  • can’t sit still

  • talks a lot

  • interrupts or acts quickly without thinking

In the criteria for ADHD diagnosis, symptoms must be...

- developmentally extreme

- cross-situational

- early onset (impairing symptoms before age 12)

- persistent and impairing (>6 months)

what is the prevalence of ADHD

- 6%-7% worldwide youth

- 2.5:1 boy:girl

Why is ADHD more prevalent now?

- much more diagnosed: direct-to-consumer ads

- true prevalence is unknown

based on CDC national survey, the rate of ADHD went up ____ from 2003 to 2017

46%

what are school accountability laws

- present in certain states

- school will be punished if test scores don't reach a certain level

- big push for academic achievement

- (rates of ADHD diagnosis for poorest kids rose rapidly in these states)

Current neurobiological models of ADHD describe it as involving poor _______ of attention as tasks change

regulation

what is the herritability of ADHD

~0.75-0.80

ADHD is associated with ____ birthweight, maternal ____ use, and extreme ____ during early years

low, drug, neglect

what evidence is there for the argument that parenting matters for the development and reinforcement of ADHD in children

- adoption studies: adopted children with ADHD "provoke" parents and cause reciprocal/transactional model

how does the neurodevelopment appear abnormal in children with ADHD

3+ year delay in development of frontal cortex and delays in synaptic pruning in adolescent years

How does peer rejection appear in children with ADHD

- about 4.5 times higher rate of negative nominations

- typically due to reaction aggression (immediate respone to perceived threat)

The __________ parenting style has been shown to be a protective factor for ADHD

authoritative

In the Hinshaw study, authoritative parenting predicted positive nominations but only in the boys with ______

ADHD

Hinshaw showed that exceptional parenting mattered most for youth with ________

ADHD (or other neurodevelopmental conditions)

what is the rate of boys vs girls with ADHD

- now 2.5:1, boys:girls

- previously believed to be 10:1

girls are more likely than boys to have the __________ type of ADHD

inattentive

Unlike boys, girls with ADHD had major problems in _________ and _________

scuicidality, cutting

Individuals with _______ are more likely to have experienced trauma and when having experienced trauma, show much higher depression and scuicde attempts

ADHD

what are the two major evidence-based treatments for ADHD

- medication

- behavior therapy

what are some not-yet-established treatments for ADHD

- diet: restriction of additives

- biofeedback

- cognitive training

- supplements

- chiropractic

Which medication in most commonly used to treat ADHD

- stimulants

- SDRIs

- SNRIs (not as effective as stimulants)

what steps are required before and during administrating medication to treat ADHD

- must establish correct dosage

- monitor side effects

- decide how long to continue

What does behavioral treatment for ADHD involve

- integration of home and school components

- parent and teacher collaboration

- manageable goals

- gradual fading of extrinsic rewards

what are the conflicts for a child victim/survivor of maltreatment when within the family

- the child wasnt to belong to the family but also wants to stop maltreatment

- child internalizes the message of not being worthy or lovable

maltreatment is far more attributable to ______________ __________ than heritability

environmental factors

what is child maltreatment

physical/sexual abuse, neglect, emotional abuse

what are the major consequences of physical abuse in children

- physical: brusies, cuts, etc.

- cognitive: mild to moderate intellectual/academic delays

- behavioral/social: peer rejection, modeling, internalization, retaliation, hostile attribution bias

what are the major consequences of sexual abuse in children

- physical: somatic concerns, STDs, STIs

- Cognitive: few overall

- Psychological: trust and intimacy issues

- Behavioral: PTSD, sleep disruption, sexual "acting out", internalizing

what is the issue with using antomically explicit dolls in the assessment of child sexual abuse

- may lead to distortions and false positives in evaluation of young children in particular

what is the most common form of child maltreatment

- neglect

- (links to poverty, stress, parental substance use, etc.)

what are the consequences of neglect in children

- physical: malnutrition, compromised health, lagged growth and developmental milestones

- cognitive: mild to moderate delays in intelligence and school achievement

- behavioral/social: withdrawal AND high activity; can vary greatly

what did the study of severe neglect in eastern europe/russian orphanages find?

- IQ recovered if child adopted before age 1

- recovery not great when child spent 3-4 years in institution

- consistently inattentive/overactive

what does emotional abuse involve in child maltreatment

- ridicule

- humiliation

- threats

- locking up child

- witnessing of domestic violence

- exploitation (forced prostitution, child labor)

which form of child emotional abuse is most linked to PTSD and externalizing symptoms

witnessing of domestic violence

what are the dangers of exposure to domestic violence

- PTSD/externalzing symptoms

- modeling, threat, terror

- trust issues

what is the issue with the current prevalence of child maltreatment

- it is largely underestimated due to a lack of reporting

in general, ______ are perpetrators of sexual abuse and ______ are perpetrators of neglect

males, mothers

what are the potential attachment and emotional regulation outcomes of child maltreatment

- disorganized attachment

- emotion dysregulation

- Fear, PTSD

- reduced empathy

what are the potential neural developmental outcomes of child maltreatment

- direct effects of physical trauma

- stress responses related to HPA axis (allostatic load)

what are the potential outcomes of child maltreatment related to self-perception

- internalized negativity

- dynamics of betrayal, powerlessness

what are the potential outcomes of child maltreatment related to psychopathology

- aggressive AND withdrawn behaviors

- mood disorders: depression, despair

- PTSD, dissociation: flashbacks, numbing, arousal

- sexual problems: "acting out", victimization

- antisocial behavior: more specific to physical abuse

Fear vs Anxiety vs Panic

- fear: FF response, HPA axis, "something is coming now"

- anxiety: anticipation, physiologically similar to fear, worry and preoccupation dominate

- panic: extreme FF response with no danger, sense of heart attack/death, agorophobia may result

when does anxiety become a disorder

- when worry is constant and causes signifcant distress

- when emotional response is disproportionate

- irrational fears that feel impossible to control

how synchronus are the components of anxiety

- physiological, cognitive, behavioral. and facial typically 0.2-0.3

- higher synchrony when anxious

like ADHD, an axiety diagnoisis can not be made until ____ and level of ________ are considered

age, impairment

why is considering age so important in diagnosing anxiety

- fears are often linked to age

- (e.g. a 3-year-old may be afraid of animals/dark, while a 7-year-old may be more afraid of embarrassment)

depression can be thought of as involving _____ neghative affect and _____ positive affect, while anxiety exclusively involves _____ negative affect

high, low, high

What are the 6 classifications of anxiety disorder in the DSM

- separation anxiety disorder

- generalized anxiety disorder

- specific and social phobias

- panic disorder (w or w/o agorophobia)

- OCD

- PTSD/acute stress disorder

what is separation anxiety disorder

- most common child anxiety disorder

- desperation when parents leave or when fear that they may leave emerges

- school refusal a severe consequence

what is the treatment for separation anxiety disorder

- expose/dont let kid escape situations away from parents (like school)

what is generalized anxiety disorder

- NOT just free floating anxiety, great many feared stimuli

- constant need for reassurance

- worries omnipresent

what are phobias

- intense, irrational, and enduring fear of an object, situation, or activity

- individual may realize fear is irrational

- symptoms can be near panic

- negatively reinforced by avoidance

what is social phobia (e.g. social anxiety disorder)

- terror of evaluation (e.g. speech, going out, performing in public)

- high prevalence in early to mid-adolescence

how are phobias treated

- classical conditioning (syst. desensitization) vs extinction (flooding)

- exposure is key element

- medications not as effective as therapy

what is panic disorder/agorophobia

- utter terror lasting minutes to over an hour

- low rate of referral as coming to office may yield symptoms

- agorophobia is fear that panic attack will occur in a situation the individual cannot escape

how is panic disorder/agorophobia treated

- exposure is crucial

- challenging of beleifs

- medications may supplement but not primary treatment

what is OCD

- consists of obsessions (intrusive, unwanted, repetitive thoughts) and compulsions (responses to obsessions to counteract them)

- may be highly severe and cause social, developmental, and physical impairment

- latechildhood-adolescensce onset

what is PTSD

- symptoms include numbness, avoidance, re-experiencing, and extreme alarm

- children can get PTSD