Exam 3-Abnormal Child Psych

Chapter 12: 

Intellectual Disability (intellectual development disorder)

Historical Labels vs Current Terminology

• The 5th edition of DSM replaced mental retardation with intellectual disability

AAMR now AAIDD

• IQ two standard deviations below the mean (70 or below)

• Adaptive behavior deficits–two standard deviations below the mean

• Before age 18–it must be present during the developmental period

• Assessed by levels of needed supports

  • Must be deficits in intellectual and adaptive functioning (especially adaptive)

  • The context/culture is important

DSM Approach

• Must occur during the intellectual period of childhood 

  • Adaptive behavior deficits in atleast two areas

  • Onset before 18

  • Categorized in levels of mild, moderate, severe, profound

  • About 85% of all cases of mild form

Intelligence & adaptive behavior

• Knowledge, ability to think or learn, capacity to adapt 

• The testing movement

  • Binet

    • Psychometric approach - g factor

    • Mental age (MA), chronological age (CA)

    • Intelligence complex, malleable, influenced by environment

  • Terman

    • Stanford-Binet

    • IQ ratio (quotient)

    • Eugenics: there is a huge bias and many tests aren’t catered toward many people of color

• Stability and validity of IQ tests

  • Stability over time - test-retest

    • Scores fairly stable

    • Lower scores more stable

  • Some debate about credibility of IQ scores

    • Reasonably good predictors of school grades, but not everything 

    • Concerns about cultural bias

  • Flynn effect: IQ scores systematically improve over time, bc the population scores are based on averages

Adaptive Functioning

• What people do to take care of themselves

• Areas often assessed:

  • Socialization skills

  • Practical skills

  • Community living/sociological context

  • Communication

• Behavior can vary across cultures

• Children with ID can experience varying levels of adaptive behavior

  • Is it situational?

Description

• Variability even within classification groups

• Increasing medical problems as level of ID increases

• Lifespan has increased, but still below average

• Specific deficits in working memory, attention, organization, 

Co-occurring disorders:

• ADHD

• Self-injury

• Aggression

• autism 

  • Variability in the severity of these disorders

  • Prevalence rates vary

  • Diagnostic overshadowing: failure to diagnose or recognize these disorders when compared to ID 

Epidemiology

• 1-3% of the general pop.

• More severe cases noticed earlier

• Dramatic shift when children enter school

• More prevalent in males (may be due to reporting bias, environment)

• More prevalent in low SES group, especially mild cases

Developmental course

• For mild ID, early intervention and training can result in a child no longer meeting the criteria for diagnosis

• The rate of intellectual development can increase or regress

• Intelligence tends to develop in a sequential way

Etiology:

• Organic vs cultural-familial 

• Organic influences vs multigenic

• Psychosocial influences

• Multifactor causation

Genetic Syndromes

• Behavioral types:

  • Down syndrome

    • Most common single disorder

    • Caused by trisomy 21: occurs randomly & not inherited

      • Decrease in brain size

    • Higher risk in maternal age

    • Alzheimer's

    • Moderate to severe ID

    • Delayed speech, verbal–short-term memory, and auditory processing deficits

    • Deficits in developmental skills during childhood

  • Fragile X

    • Most commonly inherited form fractured X chromosome

    • More common in boys– also more severe forms

    • Long faces, prominent jaws, large ears (males)

    • Visual-spatial, sequential processing, motor coordination & executive function deficits

    • Social impairments

    • Likely to have intellectual disabilities

      • Long-term memory is a strength

  • Williams Syndrome

    • Rare disorder, random

    • Deletions on chromosome 7

    • Cardiac and kidney problems, sound sensitivity, depth perception weaknesses

    • Mild to moderate ID

    • General knowledge & visual-spatial deficits

    • Relative strengths in language

      • Can be engaged with others but may have a hard time distinguishing good ppl (facial expressions)

    • “Elfinlike” appearance – may look a lot older than they are

  • Prader-Willi Syndrome

    • 70% of cases result from paternal deletion of genes on chromosome 15

    • IQ ranges from borderline to moderate impairment

    • Hyperphagia and food hoarding

    • Other compulsions, such as skin-picking

    • Strengths and weaknesses may vary depending on the cause

Family 

• Adjustment to a lifelong process

• Stressors

  • Diagnostic

  • Medical

  • Parental distress (stigma, guilt, blame)

  • Unique decisions

• Today, families viewed in a more normative way

• Factors affecting coping

  • Behavioral issues

  • Marital interaction

  • Parental IQ

  • Social class variables

  • Ethnic differences

  • Support–care and services

  • Siblings

    • Research findings mixed

• Rewards and satisfactions

  • Many families do well

  • Balance of challenging 

Assessment

• Developmental tests

• Bayley–most common

  • Both child and parent report

  • Catered to detect more severe presentations of ID

• Intelligence tests

  • Stanford Binet

• Weschler tests

  • WPPSI-IV

  • WISC-V

• Kauffman battery

  • KABC-II

• Adaptive behavior

  • Vineland adaptive behavior 

  • Scales

    • Interviews and rating scales for parents and caregivers, as well as teachers

    • Communication

    • Daily living 

    • Socialization

    • Motor skills

    • Maladaptive behavior

  • AAIDD adaptive behavioral scales

    • Guidelines for support 

    • needs in 87 areas

Intervention for IDs:

• Changing views

• Normalization

• Decreased institutionalization

• Most live at home

Prevention: 

• Prenatal care and diet

• Education on the impact of toxins

• Early intervention programs

• Educational services

  • IDEA: 

  • Inclusion

  • Academic vs functional curriculum

  • Transition

Behavioral intervention

• Discrete trial learning

• Naturalistic or incidental training (non-formal)

• Parent training

• Enhancing adaptive behavior

• Reducing challenging behavioral

  • Self-injurious behavior

Positive behavioral support

• Relies on behavioral principles, functional assessment

  • Environment modification

  • Behavioral consequences

• Functional analysis

Other interventions

• Pharmacological

  • Medications should be used with caution

  • Antipsychotic meds

    • Employed when a child exhibits behavioral problems

    • Limited evidence for efficacy

  • Psychotherapy

    • Talk therapies not widely employed or researched

Chapter 3: 

Autism Spectrum and Schizophrenia

History:

• Bleuler – schizophrenia

  • Attempted to use the term schizophrenia as hearing voices that are not here

  • Childhood schizophrenia was considered any similar disorder

• Kanner – autism

• Dsm-5 recognizes: scizophrenia & autism spectrum disorders (ASD) as separate disorders

Autism spectrum disorders:

• Characterized by:

  • Deficits in social communication and interaction

  • Restricted, repetitive, stereotyped behavior and interests

    • Hand flapping, ritualized behavior, fixation of things w/ abnormal focus

    • Symptoms must occur at an early age

• Primary symptoms:

  • Symptoms vary from child to child, including the severity

  • 3 categories ranging from low support to very high support needed

  • Social interaction

    • Deficits in joint attention behavior

    • Poor eye contact

    • Poor processing of social stimuli (lack of recognizing faces/facial expressions)

    • Difficulties with social subtleties (social cues)

  • Communication

    • Mutism or echolalia (repeating back a word) and pronoun reversals (referring to others as “I” or “me”)

    • Poor pragmatics

    • Deficits in verbal communication

    • Hyperlexia: being able to identify a word/passage yet not comprehend it

  • Restricted behavior and interests (not necessarily abnormal, but the frequency of when they do it)

    • Repetitive movements

      • Rocking, hand flapping, self-injurious behaviors

      • Persists through childhood

    • Insistence on sameness

      • Fixation on objects, tasks, hobbies, order of things

      • Is it getting in the way of school, ability to do other things, or impacting functioning?

      • Can serve as self-stimulation

    • Restricted, fixated interests

Associated Impairments

• Sensory /perceptual 

  • over/undersensitivity

  • Overselectivity: focuses on something random than what’s in front of them

• Intellectual performance

  • Higher IQ associated with better prognosis

  • Performance scores better than verbal scores

  • Splinter skills–an ability that is much higher than expected

  • Savant skills–skills are strikingly better than expected

• Adaptive behavior deficits:

  • Deficits in the function of daily life

  • Adaptive deficits increase with age

Underlying Cognitive Deficits

• Theory of mind: the ability to understand the mental states of others and oneself and how it impacts how individuals act

• Around 5 or 6

  • Sally-Anne task: (first-order task) where a child thinks what someone else is thinking

  • (second-order) when a child is able to guess what another person is thinking of based on another person

    • Kids with autism usually fail the first-order task

• Faux pas test: saying something that would harm someone else; can they recognize that it was wrong to say that word or statement

• Weak Central Coherence

  • The inability to get the gist of the conversation/information

  • Too focused on the details and not the big picture

• Executive functions

  • Underlies many autism behaviors

    • Tend to perform poor in executive functioning, but varies

    • Also seen in ADHD

    • Must take a multidefict framework in order to represent the variability in these symptoms

• Physical & other features

  • Higher than normal physical abnormalities

  • Some graceful, but others exhibit poor balance, uncoordinated gait, impaired gross motor skills

• Co-occurrence

  • Determining comorbidity is challenging because of language and cognitive problems of ASD hinder communication

  • Simple phobias, social phobias, generalized anxiety

  • Effects of ID are often not separated from those of ASD

• Epidemiology

  • Prevalence rate has been increasing

    • May be due to better identification

    • Earlier diagnosis

    • Broadened criteria

  • More prevalent in males

  • Girls are more diagnosed later in life and may display similar symptoms as boys yet not diagnosed

  • Unrelated to social class; biases in ethnicity

Developmental course

• 3 patterns of onset

  • 1st–occurs in most; abnormalities become apparent by age 1 or soon after

  • 2nd–involves regression (of ASD children)

  • 3rd–mild delays until about age 2 and then developmental arrest and plateau

• 6 trajectories

• Better prognosis with higher-functioning youths

Etiology:

• Environment & social interaction

  • 3-component function

• No demonstrated vaccine link–ASD was once associated with vaccines

  • Govt. & professional groups in the US haven't found support for the theory that MMR vaccine causes the disorder

Assessment for ASD:

• Requires a broad-based assessment

• Median diagnoses is 4-5 years

  • Interviews

  • Observations

  • Standardized checklists for autistic behaviors 

    • M-CHAT

    • CARS 2

    • ADI-R (actual autism diagnoses) 

      • Can be used on anyone 2 years and older

    • ADOS

      • Assesses children using direct observation

      • Can be used 12 months—into adulthood

  • Intellectual assessment–can be helpful for co-occurring ID, but not necessary

Prevention of ASD:

• Prenatal care

• Improvement in environmental qualities

• Early intervention

  • Behavioral approaches

    • Social skills like joint attention, imitation, language skills, behavioral regulation, & cognitive development

    • Not all children benefit from these interventions

• Pharmacological treatment

  • Atypical antipsychotics used to improve behavior

    • Risperidone: doesn't target all 

  • Stimulant meds, but some appear to have negative side effects–may exacerbate other symptoms

• Behavioral interventions (more empirical support)

  • Young autism project:

  • Pivotal response training:

  • TEACCH:

    • Home adjustment

    • Community

    • Falls into 2 approaches: Targeted vs Comprehensive

  • Programs should:

    • Be intensive, start early, be carefully controlled/systematic, promote generalization, involve parents, be flexible

Chapter 11: 

Communication and learning disorders

History: 

• Curiosity about discrepant, or unexpected, lack of abilities within individuals can be traced to work in Europe in the 1800s

• Created a more universal definition, operationalized

Definitional concerns

• Learning disabilities

  • Rely on Individuals with Disabilities Education Act for definition 

• Much debate

• Psychological processes not defined

• No criteria for identifying disabilities

Definition

• IQ-achievement discrepancy

  • Look for discrepancy between IQ and achievement (typically 2 standard deviations)

  • Has been critisized, no longer a requirement of diagnosing learning disabilities anymore

    • A flaw is that intelligence may be an underestimation of correctly diagnosing a child, other important things to consider

    • The IQ range low/high may indicate different things

    • Can fail to consider many years of issues with one subject

    • Doesn't consider environmental factors

• Below-average achievement – grade or age

  • Child performs below grade level in at least one academic  area

  • Compare performance to same-age peers on standardized tests–child scores 2 SDs below mean

  • The degree to which an individual is compared to their peers

Response to Intervention (RTI):

• Exposes children to a valid intervention before diagnosing

• Moves children through phases, levels depending on how the child is reacting to the intervention

  • Unresolved issues about the approach

Basic Components of Language:

• Phonology

• Morphology

• Syntax 

• Semantics 

• Pragmatics

• Receptive language

• Expressive language

  • After age 5, it gets harder to obtain a language and learn it

  • As children pass 2 years language increases dramatically

  • By age 7 we have many of the language skills that we need in adulthood

DSM Classification & Diagnosis:

• Speech-Sound Disorder

  • Fails to display developmentally appropriate speech sounds

• Language Disorder

  • Deficits in vocabulary, grammar, comprehension, other aspect of language output

    • Deficits in both expression & reception language

  • Children would speak in a very short manner, with unusual word order, low vocab

• Epidemiology & course:

  • Rates of 3–4%

  • More prevalent in boys

  • More prevalent in low SES (may be skewed due to dialectal differences)

  • Phonological problems tend to remit by age 6

  • Children w/ receptive language deficits at a higher risk for learning disabilities

Cognitive Deficits, theories:

• Limited information-processing capacity

  • A delayed reaction time to information

• Deficits in auditory processing

• Deficits in verbal short-term and working memory

Specific learning disorders

• A specific neurological disorder in:

  • Reading

  • Written expression

  • Mathematics

• IQ-achievement discrepancy 

• Significant disturbance in achievement and daily living

• Not due to sensory deficit

  • Have persisted 6 months +

  • Must begin during school-age years

SLD with impairment in reading

• Word-level reading problems (dyslexia):

  • Involve problems in accurate or fluent word recognition, poor spelling abilities

• Text-level reading problems (problems of comprehension)

  • Can decode words but can’t understand what they read

• Prevalence–5 to 15 % of US school-age children

• Impairments in reading is the most common type

• May be more prevalent in boys (may be referral bias)

• Disorder tends to persist into adolescence, adulthood

• Mathew effect: abilities can worsen over time

SLD with impairment in written expression:

• Errors in writing–quality

• Hard to decipher

• Disorganized content

• Transcription–putting ideas into written form

  • Poor punctuation, capitalization, word placement–handwriting & spelling central

• Text generation (composition)

  • Creation of meaning in written form: poor word memory, sentence structure, topic expansion

Epidemiology:

• 6–14% of school-age children

• Usually apparent by 2nd grade, referrals spike in 4th grade

• Prevalent in kids with ADHD 

SLD with Impairment in Mathematics

• Learn counting procedures and strategies more slowly, struggle to apply them

• Struggle to learn math terms (multiplication tables), spatial organization

  • Approx. 7% of school-age children show some form of impairment

  • Figures likely lower when cases w/ occurring reading disorders excluded

  • No gender differences found

 Chapter 10: 

Attention-Deficit/Hyperactivity Disorder

History:

• Early account–George Still, English physician, described a group of boys with a “defect in moral control”

• Encephalitis epidemic

• Terms hyperkinessis, hyperkinetic syndrome, and hyperactive child syndrome used

Three diagnostic presentations

• Predominately inattentive (ADHD-PI)

• Predominately Hyperactive/Impulsive (ADHD-PHI)

• Combine type (ADHD-C)

  • Must have some symptoms before age 12

  • Display symptoms for at least 6 months

  • Impaired social, academic, occupational functioning

  • Seen in at least 2 settings (at home/school)

  • Symptoms can’t be explained by another disorder

Inattention:

• Cannot focus consistently (sustained attention)

  • Child may play video games for hours

  • Difficult tasks increase problems

  • Usually daydream

  • Can be hyperfocused on certain tasks and can't focus at all on some tasks (boring/difficult)

• Has trouble managing simultaneous stimuli or switching from one task to another

• May focus on unimportant information

• Easily distracted

• The central problem is control and self-regulation rather than simply inattention

Hyperactivity & impulsivity

• Always on the run

• Restless fidgety

• Can't sit still

• Accident prone

• Disorganized

• More apparent in structured situations (context matters)

Impulsivity:

• Uninhibited

• Acts without thinking

• Interrupts others

• Cuts in line

• Engages in dangerous behaviors

• May be described as 

  • Careless, immature, rude

Secondary Features

• Motor skills

  • Clumsiness, delays in milestones, poor performance in sports

  • Complex movements and sequencing most affected

• Intelligence and academic achievement

  • May perform somewhat lower on intelligence tests, but a range is possible

  • Academic failure is common

    • 56% need tutoring

    • 30% may repeat a grade

    • 30-40% may receive special education placement

    • 10-35% may fail to graduate high school

• Executive functions

  • Difficulties with the processes needed for goal-directed behavior, planning, organizing, and self-regulating

    • Working memory

    • Verbal self-regulation

    • Self-monitoring

    • Inhibition of behavior

    • Emotional regulation

    • Motor control

  • Adaptive behavior

    • Immature

    • Deficits in self-care, independence, and the ability to perform everyday skills

  • Social behavior and relationships

    • Social problems are very common due to loud, disruptive, aggressive, and impulsive behaviors

    • Aggressive, negative style of interaction

      • Physical and verbal aggression toward others

    • ADHD-C may have stable, positive self-bias and be unaware of impact on others

  • Peer and teacher relationships

    • ADHD children are frequently disliked, rejected by peers

    • Teachers are directive and controlling toward other children with ADHD

  • Family relations

    • Parents less rewarding, more negative and directive

    • Certain parent and family characteristics can make the situation worse

    • Mother-child interaction may be less adept than father-child relationships

    • Parental reactions interact with the child’s behavior and vice versa

  • Health, sleep, accidents

    • Sleep problems common

      • Trouble falling asleep, night awakening, involuntary movement

      • May be related to co-occurring symptoms–anxiety/depression

      • May be related to medications

    • Higher risks for accidents

      • Bone fractures

      • Accidental poisonings

      • Car accidents/speeding tickets

Subtypes

• Most research is on ADHD-C (combined) type

• Research on ADHD-PHI (hyperactive-impulsive) type is scant

• ADHD-PI (inattentive) type may be missed

  • Sometimes categorized as “ sluggish cognitive tempo”

    • Lethargic

    • Prone to daydreams

    • Confused

    • Socially withdrawn

  • Usually 6 symptoms for each subtype

  • Debates about subtypes

Co-occurring Disorders

• ADHD-C often occurs with other disorders

  • Learning disabilities 15-40%

    • May be a result of cognitive deficits associated with ADHD or behavioral difficulties

Epidemiology

• 5 to 9% of school age children

  • Statistics may be higher due to resources, parental/teacher report

• Gender imbalance

  • Boys consistently display higher rates of the disorder (3:1 ratio to girls)

  • Girls possibly underdiagnosed

  • A bias towards reporting boys, expressed behaviors

• Social class, race/ethnicity, and culture

  • ADHD occurs in all social classes, but may be more prevalent in lower SES

  • Low but increasing among Hispanic youths vs non-Hispanic youths

  • Some studies find higher rates in AA vs white children, but others show reverse

Developmental course

• Individuals do not outgrow ADHD

• Infancy and preschool

  • Difficult temperament

  • High activity level

  • Less cooperative/manageable

  • Poor emotional regulation

    • Symptom presentation can change throughout the years & varies from child to child

• Childhood

  • Most ADHD cases are diagnosed during elementary school

  • Self-regulation and organizational deficits 

  • Peer rejection, poor academic achievement

  • ODD

• Adolescence and adulthood 

  • Symptoms may diminish/change

  • Longer-term problems may be associated with co-occurring diagnoses

Etiology:

• Neuropsychological theories of ADHD

  • Executive functions, inhibition

  • Barkley’s Model

    • Behavioral inhibition

      • Inhibit prepotent responses: responses that are likely to be reinforced

      • Interrupt prepotent responses

      • Protect form interference

    • 4 executive functions:

      • Nonverbal working memory

      • Internalization of speech (verbal working memory)

      • Self-regulation

      • reconstitution

  • Sensitivity to reward

    • High preference for immediate reward

    • Perform poorly in situations with low incentive

  • Temporal processing, aversing

    • Temporal processing 

    • Delay aversion: children tend to dislike/avoid the delay of time rather than the reward itself later

  • Multiple-pathway models

    • Dual pathways model

      • Executive function deficits

      • Delay aversion

      • Temporal processing a third pathway

    • Multiple deficit models

• Neurobiological abnormalities

  • Small brain volume associated with and severity of ADHD symptoms

  • Prefrontal lobe and striatal area associated with the core symptoms of ADHD

    • Inhibition, working memory, and other executive functions 

    • Decreased blood flow and glucose utilization, slow brain waves

  • Abnormalities in frontal, striatal, and cerebellar structures and their networks play an important role

    • Underarousal of brain

    • Dopamine and norepinephrine deficiency

    • Other brain regions are also implicated

  • A heterogeneous disorder

• Etiology:

  • Genetic influences:

    • Runs in families

    • Twin studies average heritability rate of .80, .90

    • DRD4, DAT1 genes

    • Gene-environment interactions

  • Prenatal influences & birth complications

    • Some indications that maternal smoking and alcohol use linked to ADHD

    • Birth comp linked to higher rates

  • Diet and lead

    • Diet doesn't play a role in ADHD

    • Exposure to lead associated to ADHD

  • Psychosocial influences

    • Maternal depression

    • Paternal childhood ADHD

      • Paternal warmth & sensitivity can mediate risk

      • Parent behavior, child’s temperament can interact and set the stage for more negative outcomes

    • Classroom environment, teacher management of behavior can affect a child’s presentation of ADHD

• Assessment

  • Interview

    • Strengths and weaknesses–medical history, academic history

    • Parent-child interactions

    • Child

    • Teacher interview

    • School experiences

    • Should be developmentally accurate (age-based)

  • Rating scales

  • –Can allow for the comparison to normative scores

    • Conners

      • Parent

      • Child

      • Teacher

  • Direct observation

  • –natural-based settings

    • Home and school

      • Not always practical

  • Others

    • Conners Continuous Performance Test II

    • Medical

    • Intelligence

    • Achievement

• Interventions:

  • Pharmacological:

    • Stimulant medication

    • Affect dopamine and norepineprine (taken once a day)

    • Helps in 75% of cases

    • Can reduce co-occurring behaviors, either directly or indirectly

    • May affect academic achievement

  • Concerns:

    • Stimulants don’t work for 10-20% of children

  • Side effects:

    • Sleep problems

    • Reduced appetite

    • Headaches, stomach aches

    • Irritability

    • Jitteriness

    • Growth suppression in height & weight

    • Vocal motor tics

  • Risk for later substance abuse

  • Too easily prescribed & an increase in medicated children in the past decades

  • Can be seen as a “quick fix” and used w/o additional symptomology of ADHD

• Behavioral interventions:

  • Parent training

  • Classroom management

    • Contracting

    • Daily report card

    • Educational methods

      • ADHD-I (inattentive) may need help with a slow work style 

      • Organizational skills

      • On task time

      • Transitions

      • Reduce peer reinforcement of inappropriate behavior

    • Teachers may not be able to spend their time focused on one child, helpful to support the teacher

• Multi-modal study — MTA study

  • Examined effects of medication, behavioral, combined, and community care treatment

• Follow-ups

  • Children who received medication and combined treatment still showed improvement with ADHD

  • Although children with co-occurring ADHD and anxiety benefited from just behavioral treatment alone

  • In order for it to be beneficial intervention must be throughout life over an extended period of time

• Prevention

  • Better prenatal care, healthy environment, optimal family life

  • Parent training

  • Social interactions training

Chapter 9: Conduct Problems

• Externalizing: problems with others

  • Aggression

  • Oppositional behaviors

  • Disruptive/antisocial behaviors

  • Delinquency: associated with the legal system

    • Separate from other disorders

  • Children will usually be bullies, disruptive, well beyond the normal degree

• Intermittent Explosive Disorder:

  • Not intended for children under the age of 6

  • Outbursts are generally impulsive and are not premeditated or committed to achieve a tangible objective

• Antisocial Personality Disorder (APD):

  • Diagnosed after age 18

  • Characterized by aggressive antisocial behaviors that begin by age 15 and continue into adulthood

    • Pattern of traits: lack of empathy, deceitful, arrogant, manipulative interpersonal style, impulsive and irresponsible behavioral style

Oppositional Defiant Disorder:

• Pattern of negativistic, hostile, defiant behavior lasting over six months (at least 4 symptoms per week):

  • Loses temper

  • Argues with adults (authority figures)

  • Touchy or easily annoyed by others

  • Vindictiveness

  • Actively defies or refuses to comply with adults' requests or rules

  • Deliberately annoys people

  • Blames others for his/her mistakes

• Mild presentation: displayed frequently in one setting

• Moderate: 2 settings

• Severe: displayed in 3 or more settings

• Conduct Disorder

  • Persistent pattern of behavior that violates the rights of others and age-appropriate social norms

  • 3 or more behaviors for at least 12 months

  • Behavior causes impairment

  • Childhood-onset (before age 10) or adolescent onset (over the age of 10)

    • Childhood onset more likely to persist in the future

• Aggression: bullying, cruel to animals, sexual activity

• Decietfulness (theft): lying, breaking into homes/cars, stealing

• Serious violation of rules (in an adolescent context): staying out past curfew, running away from home, 

  • Can be mild, moderate, or severe based on the number of symptoms

  • Presentation of the disorder can exhibit a lack of empathy, callous-unemotional traits

• Aggressive vs rule-breaking syndromes

• Gender differences:

  • Boys exhibit significantly higher levels of physical aggression than girls do

  • Girls more likely to engage in relation aggression

    • Manipulative, coercive actions

• Other issues:

  • Fire setting:

    • Factors: 

      • aggressive youngsters

      • Youngsters without supervision

      • High-conflict families

      • Higher rate of paternal drinking & abuse

      • Higher rates of maternal depression

  • Delinquency:

    • Legal term: juvenile who has committed an index crime or status offense

• Bullying

  • Deliberate act of hurting someone else

    • Can begin in preschool

    • Victims can experience internalizing behaviors

      • Aggressive to peers and adults

      • Positive attitude toward violence

  • Typical victim:

    • Anxious

    • Insecure

    • Nonaggressive

    • Low self-esteem

  • Having a close friend can ward off bullying or the effects

  • Bullying tied to risks of long-term problems

Epidemiology:

• Co occurrence:

  • ODD and CD

    • DSM indicates that if criteria for both are met, only CD is given

    • Most kids with CD also meet ODD criteria

  • ODD/CD and ADHD

    • 35-70% of ADHD children also develop ODD

    • ADHD tends to precede the development of others

    • Parent-child relationship has a huge effect

• Course:

  • Stability of problems over time for at least some individuals

  • Age of onset developmental pattern

    • Adolescent onset– fewer childhood problems

      • More common

      • Less likely to persist

    • Childhood onset– related to more serious, persistent problems later

• Developmental path:

  • Loeber’s three pathway model:

    • Overt 

    • covert 

    • Authority conflict
      
      

• Etiology:

  • Socioeconomics

  • Aggression as a learned behavior

  • Family influences

    • Parent-child interactions\

    • Oregon model

    • Patterson’s coercion theory

      • Negative reinforcement

      • Reinforcement trap: a child throws a fit for candy in a candy store and the mother gives it–the short-term gain leads to long-term negatives

    • Parental discipline, monitoring

      • Parents are more likely to be harsh and reprimand semi-normal behaviors

    • Parental psychopathology (parental influence)

    • Environment/ context matters if you want to change an aggressive child's behavior

 The role of media isn’t clear

• Family influences, cont.

  • Extrafamilial influences and parenta;

  • Psychopathology

    • Handing-down of poor parenting practices

    • Antisocial families

    • Social disadvantage

    • Parental substances use

  • Marital discord

    • Complex relationship

  • Maltreatment

• Peer relations

  • Cognitive-emotional influences

  • Hostile attribution bias

    • Attributing aggression to other individuals

  • Reactive vs proactive aggression

    • Reactive: angry response to something

    • Proactive: Not associated with anger–starting a fight, bullying, teasing

      • Parental supervision is a mediator

      • And higher in boys

• Biology

  • Genetics: twin studies evidence for moderate genetic influence, but environmental influences important

    • Social conditions

    • Family variables

    • Certain social learning experiences

  • Neurophysiological 

    • Behavioral inhibition system (BIS) underactive

    • behavioral activation system (BAS) overactive

    • Or both systems underactive as child tries to seek sensation

      • Reduced threshold for fight or flight in individuals with conduct problems

  • Neuropsychological

    • Frontal lobes

    • Problems with verbal and executive functions

• Substance use

  • Very common among adolescents

  • Marijuana is the most common illicit drug

  • Vs licit drugs: over-the-counter

    • DSM-5 eliminates distinction between abuse and dependence

      • Focus is on substance abuse disorders, impairment, and distress–problems with using that disorders

      • Substance-induced disorders: intoxication, withdrawal–caused by substance use, in response to the drug

      • Tolerance: need more

      • Withdrawal:

  • Epidemiology:

    • Dramatic increase in vaping

    • Alcohol most widely used substance

    • Rates of drug use rise and fall, often with rumors of benefits

    • SES and ethnic differences–studies inconsistent

    • CD and ODD highly correlated with use

      • Higher use in males

  • Use affected by:

    • Temperament

    • Self-control

    • Problem-solving

    • Emotional regulation

    • Attitudes, expectations, intentions, beliefs about control

    • Exposure to trauma, stress

    • Modeling

      • Family, peers

    • Poor academic performance and low involvement in school activities

    • Availability of substances

  • Other models of substance use:

    • Rite of passage

    • Stress and coping

Assessment

• Interviews

  • Child

  • Family

  • School

• Behavioral rating scales

  • Achenbach

  • BASC

  • Conners, Eyberg, Sutter-Eyberg, Self-report measures

• Observations

  • Parent-child observations

  • Home and school settings

Intervention

• Parent training

  • How to give commands

  • Parenting skills

  • How to reinforce behaviors

  • How to discipline

• Cognitive problem-solving skills training (PSST)

• Community-based 

  • Teaching family model (for more severe presentation)

    • Delinquets placed in home with trained foster parents

    • Transfer back home

    • Relapse common

  • Multidimensional treatment foster care

    • Only one or more youth in the foster home

    • Outside support from a larger program system

    • Intervention in multiple domains, therapy, etc.

  • Multisystemic therapy

    • Involves family, peers, school, neighborhood, and community

    • More family therapy

    • Effective in treating antisocial behavior

Prevention

• Early intervention with families of oppositional defiant children