part 4

Heritability Estimates of ADHD

Genetic factors estimated to have a heritability of 70 to 80% in ADHD.

DRD4

Dopamine receptor gene implicated in ADHD, associated with increased risk when influenced by prenatal nicotine or alcohol use.

Neurobiological Factors in ADHD

Dopaminergic brain areas are smaller in children with ADHD, affecting frontal lobe function.

Perinatal and Prenatal Factors for ADHD

Factors such as low birth weight and maternal tobacco or alcohol use can increase ADHD risk.

Two Types of CD

1. Life-course persistent: Antisocial behavior persists from childhood to adulthood. 2. Adolescence-limited: Antisocial behavior emerges during adolescence.

Etiology of Conduct Disorder

Includes genetic factors, neurobiological deficits, parenting influence, and peer rejection.

Treatment for Conduct Disorder

Includes family interventions, parental management training, and multisystemic therapy.

Depression in Children

Common symptoms include depressed mood, fatigue, problems concentrating, and suicidal ideation.

Anxiety Disorders in Children

Includes disorders characterized by excessive and persistent worry, interfering with functioning.

OCD

Obsessive-Compulsive Disorder; involves unwanted repetitive thoughts (obsessions) and behaviors (compulsions).

Genetic Factors in Learning Disabilities

Evidence from family and twin studies suggesting that genetics play a role in learning disabilities.

Developmental Disorder

Refers to a group of disorders characterized by delays in the development of socialization and communication skills.

Genetic Factors in Autism

Heritability estimates around .80; twin studies show high concordance rates for identical twins.

Treatment for ADHD: Stimulant medications (Ritalin, Adderall, Concerta, Strattera)

• Reduce disruptive behavior

• Improve interactions with parents, teachers, peers

• Improve goal-directed behavior and concentration

• Reduce aggression

• Effective in about 75 percent of children with ADHD but there are side effects

• Loss of appetite, weight, sleep problems

Treatment for ADHD

• Medication plus behavioral treatment

• Slightly better than meds alone

• Improved social skills whereas meds alone did not

• Three-year follow-up found superior benefits of meds did not persist

• Treatment for ADHD Psychological treatment

• Parental training

• Change in classroom management

• Behavior monitoring and reinforcement of appropriate behavior

• Treatment for ADHD Supportive classroom structure

• Brief assignments

• Immediate feedback

• Task-focused style

• Breaks for exercise

Etiology of Conduct Disorder

Social, Psychological and Neurobiological

Intermittent explosive disorder:

recurrent verbal or physical aggressive outbursts that are out of proportion to the circumstances.

Conduct Disorder

• Comorbid with anxiety and depression

• Comorbidity rates vary from 15 to 45%

• CD precedes anxiety and depression

Prevalence for Conduct Disorder

Boys is 4 to 16% and Girls is 1.2 to 9%

Treatment of conduct disorder

• Family interventions

  • Family check-ups (FCU) associated with less disruptive behavior

  • Parental management train (PMT)

    • Teach parents to reward prosocial behavior

• Multisystemic therapy

  • Deliver intensive community-based services

causes of conduct disorder

• Peer influences associated with CD 

  • Rejection by peers

  • Affiliation with deviant peers

• Sociocultural factors

  • Poverty

  • Urban environment

• Higher rates of delinquent acts among African American males linked to living in poorer neighborhoods rather than race

Depression and Anxiety in Children and Adolescents

• Commonly co-occur with ADHD and CD

• Also co-occur with each other

• Early research suggested that depression and anxiety could be distinguished from each other in the same way they are in adults: 

  • Depression – high negative affect, low positive affect

  • Anxiety – high negative affect but not low levels of positive affect 

  • More recent research calls this finding into question

Prevalence in depression in children and adolescents

• • 1% of preschoolers

  • 2 – 3% of school-age children

  • 6% of girls and 4% of boys during adolescence

Treatment of
Intellectual Disability

• Residential treatment

  • Small to medium-sized community residences

• Behavioral treatments

  • Language, social, and motor skills training

  • Method of successive approximation to teach basic self-care skills in severely retarded

    • e.g., holding a spoon, toileting

  • Applied behavioral analysis

• Cognitive treatments

  • Problem-solving strategies

• Computer-assisted instruction

Treatment of Anxiety Disorders in
Childhood and Adolescence

• Exposure to feared object 

  • Reward approach behavior

• CBT Kendall’s Coping Cat program

  • Shows to be effective in two randomized clinical trials

  • For children between 7 and 13 years old

  • Cognitive restructuring

    • Develop new ways to think about fears

  • Psychoeducation

  • Modeling and exposure

  • Skills training and practice

  • Relapse prevention

  • Family involved in treatment

Treatment of Depression in
Children and Adolescents

Medications

• SSRIs more effective than tricyclics

• Meta-analysis showed medications most effective for anxiety other than OCD

  • Less effective for depression and OCD

Treatment of Depression in
Children and Adolescents

Concerns about medications

• Side effects including diarrhea, nausea, sleep problems, and agitation

  • Possibility of increased risk of suicide attempts

Treatment of Depression in
Children and Adolescents

• Interpersonal psychotherapy (IPT)

  • Focuses on peer pressures, transition to adulthood, and issues related to independence

• CBT

  • More effective for Caucasian adolescents and those with pretreatment, good coping skills, and recurrent depression

• Psychotherapy generally only modestly effective with children and adolescents

  • CBT no better than non-CBT therapies

Prevelane of anxiety in children

3-5% of children and adolescents are diagnosed with anxiety disorder

Separation anxiety disorder

• Worry about parental or personal safety when away from parents

• Typically first observed when child begins school