Lecture 12 - Child and Adolescent Psychopathology - Part 1

Overview

• Disruptive, Impulse-Control, and Conduct Disorders

  • Oppositional Defiant Disorder (ODD)

  • Conduct Disorder (CD)

• Neurodevelopmental Disorders

  • Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Autism Spectrum Disorder (ASD)

  • Intellectual Disability

• Focused course: PSY:3330 Childhood Psychopathology

Oppositional Defiant Disorder (ODD)

• Characterization

  • Pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months.

  • Symptoms must be evident in interactions with someone who is not a sibling.

• Symptoms Categories

  • Angry/Irritable Mood:

    • Often loses temper

    • Touchy or easily annoyed

    • Angry and resentful

  • Argumentative/Defiant Behavior:

    • Argues with authority figures

    • Defies authority rules

    • Deliberately annoys others

    • Blames others for mistakes

  • Vindictiveness:

    • Spitefulness or vindictiveness at least twice in 6 months

• Prevalence and Age of Onset

  • More common in boys than girls before adolescence

  • Typically appears between ages 3 and 8

  • Can escalate to conduct disorder

Conduct Disorder (CD)

• Definition

  • A pattern of behavior where basic rights of others or societal norms are violated, with at least 3 of 15 symptoms present past 12 months, and at least 1 in the last 6 months.

Symptoms of Conduct Disorder

• Aggression:

  • Bullies or threatens others

  • Initiates fights

  • Uses weapons causing serious harm

  • Cruelty to people and animals

  • Confrontational theft

• Destruction of Property:

  • Deliberate fire-setting with intent to damage

  • Destruction of property

• Deceitfulness or Theft:

  • Breaking and entering

  • Lying for goods or favors

  • Theft without confrontation

• Violations of Rules:

  • Staying out at night without permission before age 13

  • Running away from home

  • School truancy before age 13

Subtypes of CD

• Childhood-onset Type:

  • At least 1 symptom before age 10

• Adolescent-onset Type:

  • No symptoms before age 10

• Unspecified Onset:

  • Criteria met but unclear age of first symptoms

Implications of Onset Age

• Childhood-onset CD:

  • More common in boys

  • Symptoms likely to persist

• Adolescent-onset CD:

  • More common in girls

  • Symptoms less likely to persist

Causes of Conduct Disorder

• Biological Factors:

  • Gene-environment interaction, such as MAOA gene and maltreatment

  • Neural systems involved in aggression

• Societal and Family Factors:

  • Exposure to drug abuse, poverty, trauma, violence

  • Problematic relationships and harsh parenting

Interventions for Conduct Disorder

• Parent-Child Interaction Therapy (PCIT):

  • In-the-moment coaching in playroom settings

  • Phase 1: Child-directed interactions

  • Phase 2: Parent-directed interactions

• Problem-Solving Skills Training (PSST):

  • Focus on cognitive deficiencies and distortions in social situations

  • Teaches handling social situations effectively

Neurodevelopmental Disorders

• Disorders with onset during developmental period, manifesting early in life.

• Influences behavior, memory, concentration, learning abilities.

Attention-Deficit/Hyperactivity Disorder (ADHD)

• Characterization

  • Persistent patterns of inattention and/or hyperactivity-impulsivity that disrupts development.

  • Symptoms generally present before age 12 and in multiple settings.

• Inattention Symptoms (6 or more for 6 months):

  • Careless mistakes, sustaining attention problems

  • Disorganization, forgetfulness, distraction

• Hyperactivity/Impulsivity Symptoms (6 or more for 6 months):

  • Fidgeting, leaving seat, excessive talking

  • Interrupting others and difficulty waiting for turns

Subtypes of ADHD

• Combined Presentation:

  • Both inattention and hyperactivity-impulsivity criteria met.

• Predominantly Inattentive Presentation:

  • Only inattention criteria met.

• Predominantly Hyperactive-Impulsive Presentation:

  • Only hyperactivity-impulsivity criteria met.

Diagnosing ADHD in Adults

• DSM-5-TR Criteria

  • At least 5 symptoms of inattention and/or hyperactivity-impulsivity.

• Importance of thorough assessment methodologies.

  • Clinical interviews, past records, self-reports, and informant measures.

Prevalence and Comorbidities

• Prevalence rates:

  • Children: 5-7%, Adults: 3-5%.

  • High persistence rates from childhood to adulthood (>50%).

• Common Comorbidities:

  • Externalizing: ODD, CD

  • Internalizing: anxiety, depression.

  • Other neurodevelopmental disorders: autism, learning disorders.

• Impacts of ADHD:

  • Executive functions, social skills, academic challenges.

Causes of ADHD

• Genetic Factors:

  • Highly heritable, influential gene studies, environmental exposures during pregnancy.

• Neurobiological Factors:

  • Structural brain differences, especially in the prefrontal cortex.

• Psychosocial Factors:

  • Parenting practices, conflict, psychopathology in parents.

Interventions for ADHD

• Medication:

  • Stimulants enhancing brain dopamine function.

  • Examples: Methylphenidate, Amphetamines.

• Cognitive-Behavioral Therapy (CBT):

  • Parent management training, focusing on effective parenting strategies and skills to cope with challenges of ADHD.