Child Psychology Midterm

Operationalizing mental illness

Use observable phenomenon such as physical symp, psychological symp, mood, beh

Communication deficits of ASD

children with ASD so early language disturbances, echolalia, pronoun reversals, literal use of words

Criteria (1/3): Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults

RAD or DSED

Continuum of disruptive behavior

Typical child beh problems --> ODD --> CD --> ASPD. 2/3 of children with ODD do not develop CD. 1/2 of children with CD also meet for ODD

Patterson's coercive hypothesis

Children learn to get their way by escalating their negative beh which leads to increasingly aversive parent interactions. As this continues over the time the rate and intensity of parent and child agg beh are increased. These patters provide reinforcement for opp and noncompliant beh and models of hostile and punative interpersonal styles

The Behavioral Characteristics we use to understand behavior

Frequency, duration, intensity, number of behaviors, pervasiveness across situations

Developmental pathways

Heterotypic continuity: heterotypic continuity occurs when a particular disorder/ behv predicts another disorder at a later time point . ex.Antisocial behavior --> tantrums, aggression, substance abuse, criminal beh

Biological Risk factors

1. Genes

2. neurotransmitters

3. blood flow

4. brain damage

5. toxins

6. hormones

7. temperament

8. illness

9. infection

10. pregnancy trauma

11. birth trauma

DSM-5 20 diagnostic groups

Neuro dev, schizophrenia spectrum and other psychotic ds, bipolar and related ds, depressive ds, anxiety ds, OC and related ds, trauma and stressor related ds, dissociative ds, somatic symptom ds, feeding and eating ds, elimination ds, sleep-awake ds, sexual dysfunction, gender dysphoria, disruptive, impulse control and conduct ds, substance use and and addictive ds, neurocog ds, personality ds, paraphillic ds, other ds.

ASD criteria

A. persistent deficit in social communication and social interaction across contexts (3+)

B Restricted Repetitive patterns of behavior interest or activities (2+)

C. Symptoms must be present in early childhood.

D. Symptoms together limit and impair every day functioning.

Symptom: Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings

DSED

Symptom: is often touchy or easy annoyed

ODD

Symptom: often actively defies or refuses to comply with adult requests

ODD

Symptom: often deliberately annoys others

ODD

Conduct Disorder Criteria

3+ from any of the categories in past 12 mo, w/ one present in past 6 mo. Aggression to people and animals

Destruction of property

Deceitfulness or theft

Serious violations of rules

Three different types of hyperactivity

1. Gross motor activity

2. Restless/ squirmy

3. Occasionally verbal hyperactivity

ADHD developmental progression

Difficult infant temperament --> initial development during preschool years --> decline in hyperactivity and impulse control in adolescence (still meet crit). Over 50% continue to display sympt into adulthood

peer social problems with ADHD

can be bothersome, stubborn, socially awkward and socially insensitive. Often disliked and rejected by peers. Unable to apply their social understanding in social situations. Positive friendships can buffer the neg outcomes of ADHD

The Developmental Processes we use to understand behavior

Age, gender, dev stage, cognitive level, age of onset

Four broad contexts to understand behavior (case conceptualization vibes)

1. Developmental process

2. Behavioral Characteristics

3. Biological, psychological, and social-env factors

4. Parenting factors

Developmental approach to psychopathology

Emphasizes biological, psychological and social (env) vulnerabilities and risk factors in interplay w/ each other in the context of dev process and beh characteristics

Cicchetti DP approach

not a static set of diagnostic entities, but a the failure to obtain core developmental competencies leading to a progressive veering from normal developmental trajectories,

and an accumulation of maladaptive behaviors in most contexts,

even though at least some of these behaviors are adaptive in certain contexts or may have been adaptive in harsh early environments

Goals of Developmental Psychology

1. Understand a range of processes and the mechanisms behind them

2. How it changes over time

3. How it is influenced by child dev capacities and the context of them

4. How assessment and treatment impact psychopathology

General principals of developmental psychopathology

1. Employs many theories to understand dev of disordered and non-disordered behaviors

2. Stresses understanding both risk and protective factors

3. Explores multifinality and equifinality

Developmental cascades

when a child's previous experiences and interactions may spread across other systems and alter their course of development. ex. Both stress life events and bad parents can disrupt the dev of inhibitory control which leads to subsequent substance use

Theories in Dev Psych

Biological model, cognitive, social-cognitive, cognitive-behavioral, behavioral, attachment and parenting, family systems, psychodynamic and psychosocial

Biological model (basics)

Genes, temperament, neurotransmitters, brain structures.

Who created the Cognitive Model

Piaget

Social-Cognitive Model

Bandura, Dodge

Cognitive-Behavioral Model

Beck, Seligman, Ellis

Behavioral Model

Watson, Skinner

Attachment and Parenting

Ainsworth, Bowlby, Baumrind, Eyberg

Family Systems

Minuchin

Psychodynamic

Freuds, Mahler

Who created Psychosocial Model

Erikson

Chichetti and Toth

Ecological Transactional: Created term developmental psychopathology

Bandura

Reciprocal determinism: child and parent mutually influence each other

Sameroff and Chandler

Transactional Model: ongoing and interactional nature of developmental change between child and env

Env risk factors

cultural/ethnic, education, poverty, divorce, victim of abuse, observer of abuse, neglect, lack of stimulation, peers, learning exp

Biological components of the bio-psycho-social model

Family history, genetics, biochemistry, physical development, intelligence, temperament, medical comorbidities, developmental and birth history, puberty

Psychological components of the bio-psycho-social model

env dev, personality, attachment, self-esteem, insight, patterns of beh, patterns of cog, response to stressors, coping strats

Social components of the bio-psycho-social model

family dynamic, parenting style, parents as role models, peer relationships, school, neighborhood, ethnicity, SES, culture, religion

Components of case conceptualization

Identifying information, reason for referral, dev history, family background, interview and assessment results, etiology, diff dx, treatment

What the DSM-5 includes

Diagnostic criteria, associated features, age of onset, typical course, prevalence

What the DSM-5 does not include

etiology, treatment, cultural implications

Why we use a diagnostic system

communication, research, treatment

Broad changes to our diagnostic system

dimensions within categories, how various conditions relate, occurrence of mental disorders across the lifespan

DSM-5 Changes relevant to children

1. No more separate section of child disorders

2. Intellectual disability (no longer MR)

3. Social Communication Disorder

4. ASD (no PDD or asperger's)

5. Specific Learning Disability (no longer separate LDs)

6. ADHD dx extended to adults, added adult ex, changed subtypes to presentations

7. SAD and SM moved to anxiety disorders

8. DMDD added and put under depressive disorders

9. New trauma section added w/ RAD and DSED

10. New section for disruptive, impulse-control, and conduct disorders

Symptom: Deficits in social-emotional reciprocity

ASD

Symptom: deficits in nonverbal communicative behaviors used for social interaction

ASD

Symptom: deficits in developing and maintaining relationships

ASD

Symptom: stereotyped or repetitive speech, motor movement, or use of objects

ASD

Symptom: excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change

ASD

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

ASD

Symptom: hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of environment

ASD

Social world challenges of ASD

rarely approach, may look through ppl, problems in joint attention, look at diff parts of the face than others such as mouth, these beh contribute to difficulties in perceiving emotion in other ppl

Theory of mind w/ ASD

understanding that other ppl have diff desires, beliefs, intentions, and emotions. Crucial for social relationships, Typically develops between 2.5 and 5 yo. ASD do not achieve this

Repetitive and ritualistic acts in ASD

extremely upset when routine is altered, obsessional play, ritualistic body movements, attached to inanimate objects

ASD and RAD both having the outcome of social communication deficits is an example of what?

Equifinality

Early childhood abuse leading to either RAD or DSED is an example of what?

Multifinality

Reactive Attachment Disorder (RAD) Criteria

A.Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:

1.Rarely or minimally seeks comfort when distressed

2.Rarely or minimally responds to comfort when distressed

B.Persistent social and emotional disturbance (2+)

C.Child has had a pattern of extremes of insufficient care (1+)

D.Care in Criterion C presumed responsible for the disturbed behavior in Criterion A.

E.Criteria are not met for autism spectrum disorder.

F.The disturbance is evident before age 5 years.

G.The child has a developmental age of at least 9 months.

Symptom: the child rarely or minimally seeks comfort when distressed

RAD

Symptom: The child rarely or minimally responds to comfort when distressed

RAD

Symptom: Minimal social and emotional responsiveness to others

RAD

Symptom: Limited positive affect

RAD

Symptom: Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interaction with adult caregivers

RAD

Criteria (2/3): Repeated changes of primary caregivers that limit opportunities to form stable attachments

RAD or DSED

Criteria (3/3): Rearing in unusual settings that severely limit opportunities to form selective attachments

RAD or DSED

Disinhibited Social Engagement Disorder Criteria

A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar

adults (2+_

B. The behaviors in Criterion A are not limited to impulsivity (as in attention-deficit/hyperactivity disorder) but include socially disinhibited behavior.

C. The child has experienced a pattern of extremes of insufficient care (1+)

D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g:, the disturbances in Criterion A began following the pathogenic care in Criterion C).

E. The child has a developmental age of at least 9 months.

Symptom: Reduced or absent reticence in approaching and interacting with unfamiliar adults

DSED

Symptom: Overly familiar verbal or physical behavior

DSED

Symptom: Willingness to go off with an unfamiliar adult with minimal or no hesitation

DSED

Differential Diagnoses between RAD and ASD

RAD requires a specific event prior to onset, RAD does not include restrictive interests, unusual sensory reactions, and repetitive behavior (although not stereotyped behaviors)

Davidson et al. (2015) Social Relationship difficulties in autism and RAD: improving diagnostic validity through structured assessment

Background: Little previous research on standardized measurements differentiating between ASD and RAD

Methods: children with ASD matched on aged with those with RAD, analysis done to find features that best discriminate the two

Results: according to parent report, children with ASD presented with sig fewer indiscriminate friendliness bhvs compared to RAD

Conclusion: Children with RAD and ASD may demonstrate similar social relationship difficulties but there is a difference in the social quality of the interactions. For a small portion of those with subtle ASD it may be harder to differentiate. Structured obs was best discriminatory tool

Top four comorbid diagnosis with RAD (in order)

Anxiety disorders, ADHD, Conduct, and PTSD

Top three comorbid diagnosis with ASD (in order)

ADHD, Anxiety disorders, Motor tics

PTSD in children younger than 6 (as a function of parental abuse)

intrusive thoughts and beh, rumination, hypervigilance, oppositionality, mood swings, mania, interruption with potty training, sexual preoccupation, guilt, threatens others

Disruptive, Impulse-Control, and Conduct Disorders

ODD,

intermittent explosive disorder,

CD,

pyromania,

kleptomania,

Other specified and other unspecified

Four categories of disruptive behavior

Destructive vs Nondestructive

Covert vs overt

Oppositional Defiant Disorder (ODD) Criteria

A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, involving 4+ from any of the angry/irritable mood, argumentative/ defiant behavior, or vindictiveness categories

B. Beh must occur more frequently than typically observed of children their age. For children less than 5 should be most days for 5+ should be 1x a week

c. Impairment

d. rule outs- psychotic, substance, depressive disorders, Bipolar, or DMDD

Symptom: often loses temper

ODD

Symptom: is often angry and resentful

ODD

Symptom: often argues with authority figures or adults

ODD

Symptom: often blames others for his or her own mistakes

ODD

Symptom: is often spiteful or vindictive

ODD

ODD bio-psycho-social factors

parenting: coercive cycle

temperament: dysregulation and impulsivity

Genetic: fam history of ADHD, substance, anxiety, and mood disorders

Neurological: brain differences for reasoning, judgment and impulse control

Cog: inaccurate identifying of social cues from peers

Family Cycle of challenging child behavior

dysregulation etc --> more parenting demands --> increased behavioral problems --> rising parent stres --> emotional problems --> parenting effectiveness decreases -> more parenting demands

Better family cycle of challenging child behavior

dysregulation etc --> parenting skills --> increased child engagement --> better parent coping --> positive behavior --> effective parenting --> parenting skills

Parent-child coercive cyle

child makes a demand --> parent refuses --> child throws a fit --> parent gives in --> child quiets down --> which reinforces parent

Age of emergence for oppositional behaviors

Age 3: acts stubborn

Age 5: defies adults, temper tantrums

Age 6: irritable, argumentative, blames others

Age 7: annoys others, spiteful and angry

Prevalence of ODD

one of the most common referrals. 1/3-2/3 of child referrals. More boys prior to adolescence but during adolescence rates increase for both

ODD comorbidities

Highly comorbid with ADHD and CD. Also with anxiety and depression.

Intermittent Explosive Disorder Criteria

A. Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property

B. The degree of assaultiveness during these episodes is grossly out of proportion to any precipitating stressors

Important rule outs: ASPD, CD, ADHD

Specifiers for conduct disorder

1. Childhood-onset type: 1+ problem before 10 yo

2. Adolescent-onset type: no symptom before age 10

3. Unspecified onset: Not enough info

w/ callous unemotional presentation

Severity: Mild (3-4), Moderate (btw the two), Severe (10+)

Change in CD criteria in DSM-5

addition of the specifier: w/ callous-unemotional presentation. Must show 2+ limited prosocial emotion (lack of guilt, lack of empathy, unconcern over performance, and shallow affect) at least 12 mo across settings and relationships

CD neurobiological etiology

Poor verbal skills, difficulty with executive functioning, low IQ, lower physiological measures of arousal (sweat, heart)

CD psychological etiology

deficient moral devel, modeling/reinforcement of agg beh, harsh and inconsistent parenting, lack of parental monitoring, cog bias (hostile att)

CD Development and progression

Age 8: lies, fights

Age 9: bullies, fire setting, weapon use

Age 10: Vandalizes

Age 11: physical cruelty

Age 12: steals, runs away, truant, breaks and enters

Age 13: forced sexual activity

Risks with CD

Early onset of: drinking, smoking, sexual beh, illegal drug use

Increased adult risk: criminal beh, incarceration, alcohol abuse, marital discord, occupation impairment, social impairment, up to 40-50% will develop ASPD.

ASPD Criteria

A. Disregard for violation of others rights since age 15, as indicated by 1 of the 7 sub features:

1. Failure to obey laws and norms by engaging in behavior which results in criminal arrest, or would warrant criminal arrest

2. Lying, deception, and manipulation, for profit or self-amusement

3. Impulsive behavior

4. Irritability and aggression, manifested, as frequently assaults others, or engages in fighting

5.Blatantly disregards safety of self and others

6. Pattern of irresponsibility

7. Lack of remorse

B. At least 18