Child and Adolescent Pathology exam 1

Serious violations of rules

13. often stays out at night despite parental prohibitions, beginning before age 13 years 14. has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) 15. is often truant from school, beginning before age 13 years

With limited prosocial emotions: at least ___ of the following characteristics are present and persistent over ___ months and in multiple relationships and settings.

2, 12

__ to __% of children with CD later develop APD, a pervasive pattern of disregard for, and violation of the rights of others, as well as engagement in multiple illegal acts

25 40

▪ ___% devp CD ▪ __% maintain ODD ▪ __% "desist" (no longer meet criteria for ODD)

25 50 25

symptoms under Argumentative/Defiant Behavior

4. Argues with authority figures or, for children and adolescents, with adults 5. Actively defies or refuses to comply with requests from authority figures or with rules 6. Often deliberately annoys others 7. Often blames others for mistakes or misbehavior

Cognitive theories (information processing and cognitive-behavioral theories)

cognition is the mental processes that include attention, memory, learning, problem-solving, and decision making.

Biological

cognitive functioning, intellectual disabiliity

Adolescents with ____ and ____ were at greatest risk for engaging in bullying behavior.

conduct problems CU traits

compared to CD and ODD, intermittent Explosive Disorder has less of a ____ pattern. It is less ___

persistent chronic

o Children and adolescents with CU traits are more likely to show the combination of ___ and ___ aggression.

reactive proactive

Schemas

content + structures (what is stored and the way it is stored)

Abnormal development involves ____ and ___ with both quantitative and qualitative changes in patterns of behavior over time (some are stable but others not across development)

continuities and discontinuities

For those in the childhood- onset group (i.e., without CU traits), their problems in emotional and behavioral dysregulation and associated cognitive biases can place the youth at risk for rejection by ____, depriving them of important peer socializing experiences that foster the development of social and cognitive skills

conventional peers

Community boys and girls scoring high on CU traits and conduct problems reported having friends, but that their friends tended to be more ____ than were the friends of youth with CU traits or conduct problems alone.

delinquent

Higher encoding of negative information & lower encoding of positive information leads to

depression

•different pathways lead to a similar outcome

equifinality eg, all kids all have same outcome, conduct disorder. Some of those kids have strong genetic risk for conduct probs. Some have family characteristics.

Age of onset?

evidence is beginning to appear that suggests the com- bined subtype has an earlier onset and age of referral than the inattentive subtype Thus, the DSM-IV field trials for ADHD found that only 57% of youths meeting symptom criteria for ADHD/I also met the criterion for age of onset before seven years, whereas 82% of youths meeting symptom criteria for ADHD/C met the age of onset cri- terion Finally, Faraone, Biederman, Weber, and Russell (1998) found that the combined group had significantly earlier age of onset (2.9 vs. 4.0 years) and referral age (6.4 vs. 9.2) than did the inattentive group. In contrast to these significant differences, Barkley et al. (1990) failed to find a difference in age at time of study Page 19 of 34 between their ADD/H group (8.3 years) and their ADD/WO group (9.0 years). Further, one community-sample study found no differ- ences in age of onset (Gaub & Carlson, 1997). ***the evidence suggests that the combined type is identified and referred at an earlier age.

protective factors hypothesized to buffer the impact of risk factors on children's behavior problems...in adulthood?

factors that serve to disconnect individuals from earlier negative influences and provide them with new opportunities in adulthood (e.g., military service, marriage) may protect socially disadvantaged antisocial youth from showing behaviors that persist into adulthood.

social

family, peers, school

Children with CU traits differed from those without CU traits by showing a distinct temperamental style characterized by low ___ and high reward ___.

fearfulness dominance

Ecological models

focus on family, social and cultural influences and describe the child's environment as a series of nested and interconnected structures that together determine child outcomes.

LCP CD was associated with a broad range of risk factors, including

inadequate parenting (e.g., family conflict, maternal mental health problemss, harsh or inconsistent discipline) neurocognitive problems (e.g., neurological deficits, low IQ) difficult temperament co-morbid behavior problems (e.g., hyperactivity, fighting, peer rejection).

The behaviors of oppositional defiant disorder are typically of a ____ severe nature than those of conduct disorder

less

o Predominantly Inattentive Type (ADHD-PI) characteristics

less common deficits in selective or focused attention & information processing speed (i.e., "sluggish cognitive tempo") problems retrieving verbal information from memory visual-spatial deficits may be co-morbid with learning disorders, difficulties with information retrieval greater problems w/ anxiety/mood disorders, social withdrawal, and general unhappiness less likely to exhibit externalizing symptoms described as "more daydreamy, hypoactive, passive, apathetic, lethargic, confused, withdrawn and sluggish"; can be shy

▪ These girls also experience negative outcomes themselves, including __, __, __, and ___

loneliness social isolation depression peer rejection

Emotional Factors ____ and deficits in _____ places children with ADHD at higher risk for ODD

low effortful control emotional self-control

Youth with CU traits appear to constitute a ____ of those within the childhood- onset group

minority

___ refers to the sequence and timing of behaviors, and the relationship between them over time.

pathway

____ and ____ who show high levels of antisocial behavior.

peer rejection affiliation with deviant peers

o Girls use more indirect, ____ aggression (Crick & Grotpeter, 1995), or attempts to inflict harm upon another person by manipulating and damaging social relationships.

relational

It can lead to problems in the development of conscience, whereby the children become so focused on the potential ___ and ____ gains of aggression or other antisocial means to solve interpersonal conflicts that they ignore the potentially harmful effects of this behavior on themselves and other

rewards instrumental

Reconstitution

the ability to analyze a situation and synthesize multiple pieces of information to identify a novel appropriate response

▪ Internalization of speech

the ability to use language to think through our options and choose the best one.

describe Patterson's coercive theory of child behavior problems

the child learns to use increasingly intense forms of noxious behavior to avoid unwanted parental demands; the parent learns via an escape-conditioning sequence to give up making demands and providing consequences for misbehavior.

•Snares definition?

the consequences or features of antisocial behavior that serve to limit options for escaping an antisocial lifestyle eg when school fights lead to expulsion. Now expelled so either in alternative program or never finish, that limits employment.

Cognitive content

the content, or substance/themes, that are organized and stored

Other personality features, such as ____, _____, and ____, may also distinguish those with characteristics described in the specifier.

thrill seeking fearlessness insensitivity to punishment

anti social behaviors show considerable stability across the lifespan, but the ___ of antisocial behaviors change markedly over the years

types

The indicators of the specifier with limited pro-social emotions are those that have often been labeled as ___ and ____ traits in research.

callous unemotional

Cognitive deficits or distortions or behaviors

can interfere w/ emotional regulation & lead to situationally inappropriate reactions

criteria B?

A. Magnitude of aggressiveness is grossly out of proportion to the provocation/stressors

Intoxication:

Clinically significant problematic behavioral or psychological changes associated with effects of the substance (e.g. belligerence, mood lability, impaired judgment)

substance abuse that is associated with family history of use, abuse or dependence and conduct problems

Early Escalating Type

1.

1.Verbal aggression (e.g., temper tantrums, tirades, verbal arguments or fights) or physical aggression toward property, animals, or other individuals, occurring twice weekly, on average, for a period of three months. The physical aggression does not result in damage or destruction of property and does not result in physical injury to animals or other individual.

Motor control:

prunes unwanted movement and defends against interference until long complex tasks can be completed.

Some argue that DSM-5 criteria for substance use disorders, which is based on adults, might be inadequate for adolescents. Name four arguments that support this view.

-Adolescents are just beginning consumption, and thus more likely to exhibit tolerance. -Withdrawal is exhibited by a very small number of adolescents. -The hazardous use criterion may be less relevant bc youth have less access to motor vehicles. -Youth meet diagnostic criteria at lower levels of use than adults, but they are also more neurobiologically sensitive to the effects of substances, so less use might be more problematic.

Adolescent Onset Pathway risk factors

-An exaggeration of a normal process of rebellion and identity formation -Peer rejection & association w/ deviant peers (support rebelliousness)

What three groups exhibit even higher heritability rates than those with antisocial behavior alone?

-Conduct problems + aggression -Childhood onset conduct problems -Children with callous-unemotional traits

Callous-lack of empathy

-Disregards and doesn't care about the feelings of others -Cold and uncaring -Makes the situation about themselves even when they have hurt someone else

o Childhood Onset Pathway (no CU traits) risk factors

-High emotional reactivity -Executive functioning, low verbal ability, hostile attribution biases - Peer rejection & association w/ deviant peers (poor peer socialization)

What is emotional factors are inherited in CD-Childhood Onset Pathway (with CU Traits)?

-Low emotional reactivity to signals of fear and distress in others, reduced recognition of fear and sadness in others -"Fearless" temperament, lower fearful responses to punishment cues, risk for deficits in the normative development of conscience

Callous Unemotional Traits Childhood Onset Pathway risk factors

-Low emotional reactivity, especially to fear/distress in others, "fearless" temperament -Beliefs supporting instrumental gain from aggression -Perform poorly in "reversal learning" -Impact early precursors to empathy, moral reasoning and sensitivity to punishment

protective factors hypothesized to buffer the impact of risk factors on children's behavior problems...in childhood?

-Maternal support or responsiveness and secure child attachment. - warm and involved parenting may buffer against the development of CU traits, in particular among children with risky fearless temperament. - practices not relying solely on punishment but instead focusing on the positive qualities of the parent- child relationship, are more effective in promoting conscience development in relatively fearless children.

what is cognitive factors are inherited in CD-Childhood Onset Pathway (no CU Traits)?

-More severe deficits in verbal intelligence -More hostile attributional bias

There was an identifiable stressor, but the child meets criteria for another mental disorder. What do I do?

Go with the other mental disorder.

what is cognitive factors are inherited in CD-Childhood Onset Pathway (with CU Traits)?

-View aggression as acceptable means to a goal, blame others, emphasize dominance and revenge in social conflicts -Expect more instrumental gain from aggression vs. peers -Perform poorly in "reversal learning" (difficulties changing a previously rewarded behavior following a change to punishment) -Believed to impair moral reasoning

Deceitfulness or theft

10. has broken into someone else's house, building, or car 11. often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others) 12. has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

2.

1.Three (3) behavioral outbursts involving the damage of property and/or injury of a person/animal within a 12 month period

symptoms under angry/irritable mood

1. loses temper 2. touchy or easily annoyed 3. angry and resentful

In Ch. 1 of your textbook, the authors identify several factors complicating the study of child psychopathology. Name three such problems and describe how they make it difficult for researchers and clinicians to fully understand how child mental health problems emerge.

1. many childhood problems are not narrow in scope or expression, and most forms of psychopathology in children are known to overlap and coexist with other disorders. 2. Issues concerning the conceptualization and definition of psychopathology in children continue to be vigorously debated. 3. Distinct boundaries between many commonly occurring childhood behaviors and those problems that come to be labeled as disorders are not easily drawn. There is mounting evidence that most forms of psychopathology differ in degree from normative behavior, rather than in kind.

Aggression to people and animals

1. often bullies, threatens, or intimidates others 2. often initiates physical fights 3. has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun) 4. has been physically cruel to people 5. has been physically cruel to animals 6. has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery) 7. has forced someone into sexual activity

Destruction of property

8 has deliberately engaged in fire setting with the intention of causing serious damage 9. has deliberately destroyed others' property (other than by fire setting)

symptom under Vindictiveness:

8. Spiteful or vindictive at least twice within the past 6 months

___% of kids w/ CD previously met ODD criteria and many retain it

90

Oppositional Defiant disorder criteria A

A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms of the following categories, and exhibited during interaction with at least one individual who is not a sibling:

criteria A for conduct disorder?

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:

ADHD criteria?

A. Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, characterized by 1 and/or 2: (1) Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities a. often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities b. often has difficulty sustaining attention in tasks or play activities c. often does not seem to listen when spoken to directly 2. Hyperactivity and impulsivity: six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities a. often fidgets with or taps hands or feet or squirms in seat b. often leaves seat in situations when remaining seated is expected d. often unable to play or engage in leisure activities quietly B. Several inattentive or hyperactive symptoms were present prior to age 12 years C. Several inattentive or hyperactive symptoms are present in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities) D. There is clear evidence that the symptoms interfere with, or reduce quality of, social, academic, or occupational functioning E. Symptoms are not better explained by another mental disorder Three types of ADHD are identified. Specify whether: ADHD, Combined Presentation: if both criteria A1 (inattentive) and A2 (hyperactive/impulsive) are met for the past 6 months ADHD, Predominantly Inattentive Presentation: if criterion A1 is met but criterion A2 is not met for the past six months ADHD, Predominantly Hyperactive-Impulsive Presentation: if Criterion A2 is met but Criterion A1 is not met for the past six months.

Criteria A for Intermittent Explosive Disorder (IED)

A. Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either of the following

Name three prominent underlying assumptions in the area of abnormal child psychology

Abnormal behavior is multiply determined (risk and protective factors operating on multiple levels, nature vs. nurture) Some aspects of abnormal development are interdependent which means that there are some aspects that depend on each other Abnormal development involves continuities and discontinuities: both quantitative and qualitative changes in patterns of behavior overtime (some are stable but others not across development)

four categories of conduct disorder symptoms

Aggression to people and animals, Destruction of property, Deceitfulness or theft, Serious violations of rules

Milich and colleagues (2001) argue that ADHD-Combined Type and ADHD-Primarily Inattentive Type may not be two subtypes of the same disorder; they may, in fact, be two distinct and unrelated disorders. The authors reviewed empirical studies examining differences between ADHD-C and ADHD-PI on the essential features of ADHD. What did they conclude regarding: (a) attention problems?

Although there are few studies spe- cifically examining the nature of the attention problems for the two ADHD subtypes, the available studies suggest that the two subtypes may experience dramatically different types of attention problems. Items relating to this sluggish cognitive tempo were included in the DSM-IV field trials for ADHD (Frick et al., 1994), but they were not included in the final symp- tom lists for ADHD. Carlson and Mann (in press) tested this possibility by subdividing a sample of diagnosed ADHD/I children into two groups depending on whether they showed elevated scores on the two SCT items of "daydreams or gets lost in his/her thoughts" and "underactive, slow moving, or lacks en- ergy." Comparing the two groups on teacher rat- ings revealed that the high SCT group was rated higher on internalizing problems and lower on externalizing problems than the low SCT group. On measures relating to internalizing problems, the ratings of the low SCT group were more similar to those of the ADHD/C group than they were to the high SCT group. Lahey, Schaughency, Frame, and Strauss (1985) examined a school sample of ADD/H, ADD/WO, and normal con- trol children using teacher ratings on the Revised Behav- ior Problem Checklist (RBPC). the two ADD groups differed from each other on seven of the items. ADD/H children were rated higher on the irresponsibility, distractibility, impulsivity, sloppiness, and answering without thinking items. The ADD/WO children were rated higher on the sluggishness and slowness items. On the Teacher Rating Form, ADD/WO children were rated higher than ADD/H children on items "lost in a fog," "daydreaming or getting lost in thought," and "apathetic or unmotivated." MAIN POINT:items dealing with a sluggish cognitive tempo may well be the most sen- sitive items for differentiating the attention problems of the combined and inattentive groups. Within the inattentive subtype there may be at least two different manifestations of the problem; a group high on items relating to the sluggish cognitive tempo and high on internalizing problems, and a group that may be more similar to the combined type but having fewer hyperactive/impulsive symptoms, resulting in these children incorrectly receiving an inattentive subtype diagnosis. the diagnostic system needs to put a limit on how many hyperactive/impulsive symptoms a child can demonstrate and still receive an ADHD/I diagnosis. As it stands now, a child can have five H/I symptoms and still receive an ADHD/I diagnosis. This obviously produces a heterogeneous group of children, some of whom may be considered purely inattentive and some of whom probably could be classified as subclinical combined type Barkley (1997) and others have speculated that the combined and inattentive subtypes may exhibit different types of atten- tion problems, with the former exhibiting more distracti- bility and the latter more passive-inattentive behavior

E.

At least six years old (or equivalent developmental level)

social functioning

Both ADD groups received fewer "most liked" peer nominations and more "least liked" peer nominations than the control group. However, it was also found that ADD/H children received even more "liked least" nomi- nations than ADD/WO children ADD/H boys were rated as more unpopu- lar than ADD/WO boys. However, ADD/WO boys were rated as more socially withdrawn. the combined group showed more aggressive solutions to social problems, whereas the inattentive group showed more passive behavior The inattentive boys were observed to engage in high lev- els of solitary, on-looking behavior and low levels of sustained interactions compared to the control boys and boys with the combined subtype. In terms of peer nomina- tions, the inattentive group received significantly more "shy" nominations than the combined group, whereas the latter received more "starts fights" nominations than did the other two groups. .******These findings document that even though both the inattentive and combined subtypes have significant peer problems, these difficulties appear to reflect different behavioral etiologies. Together, the findings from studies assessing ADHD children's social functioning indicate that, although both ADHD/I and ADHD/C groups exhibit social impair- ment, ADHD/C children appear to display more social problems, such as fighting (Hodgens et al., 2000), and are more likely to be actively rejected by their peers than ADHD/I children (Wheeler & Carlson, 1994). In con- trast, there is some evidence to suggest that the inattentive group is more likely to exhibit passive, withdrawn behav- ior

§More hostile attributional bias (things people do are hostile or they do things on purpose)

CD-Childhood Onset Pathway (no CU Traits)

Adolescents with high levels of ___ traits may be more likely to commit crimes in groups and show the highest level of association with delinquent and antisocial peers

CU

Social- cognitive deficits (e.g., a tendency to emphasize the rewarding aspects of aggressive behavior and ignore the punishments) and some of the emotional characteristics (e.g., lack of emotional responsiveness to provocation) that are associated with proactive aggression may be more specifically associated with _____ traits

CU

diagnose _____ if isolated incidents of conduct problems that can be coded as a V code. Its really just one thing that the kid does e.g., the kid just chronically lies or on a few occasions has stolen from a peer

Child and Adolescent Antisocial Behavior

▪ More severe, deviant behavior

Childhood Onset Pathway (no CU traits)

evidence that ADHD is real.

Children with ADHD have reliably reduced brain size from age 4 on Slower maturation of the cortical mantle Elevated levels of lead in their blood More family members with ADHD Differences in genotype

hyperactivity/impulsivity?

Conte, Kinsbourne, Swanson, Zirk, and Samuels (1986) compared performances of ADD/H, ADD/WO, and control groups on the MFFT, a pur- ported measure of impulse control. Somewhat surprisingly, it was found that the ADD/WO group had shorter latencies than the ADD/H and control groups Additionally, the ADD/WO group made more errors than the control group, suggesting that the ADD/WO group was the most impulsive of the groups examined. Finally, Trommer, Hoeppner, Lorber, and Armstrong (1988) administered the go/no-go paradigm to ADD/H, ADD/WO, and normal control children. In this paradigm, children were required to raise and lower their index finger in response to hearing a single tap (go signal) and refrain from responding to a double tap (no-go signal). All children demonstrated the ability to respond properly to both sig- nals. ADD/WO children made more commission errors (which is suggestive of impulsivity) as well as more overall errors on the first trial than did ADD/H children and normal control children. However, ADD/WO children improved more on the second trial than did ADD/H chil- dren, who committed an equal number of commission errors on both trials. Taken together, these studies offer few reliable differences between the combined and inattentive subtypes on laboratory measures of impulsivity, with results from the MFFT being contradictory. The authors com- pared combined and inattentive subtypes along with a normal control group on a stop-signal task, a well- validated measure of behavioral inhibition (Oosterlaan, Logan, & Sergeant, 1998). Nigg et al. found a deficit in behavioral inhibition for the combined group, even after controlling for comorbid ODD/CD symptoms. No such deficit was found for the inattentive group The Nigg et al. (2000) study appears to be the only investigation specifically documenting that the combined group may have problems in disinhibition that are not present in the inattentive group, despite the fact that such problems are the major defining feature in differentiating the two groups

Barkley argues for the existence of SCT (or concentration deficit disorder) that can be readily distinguished from ADHD. According to Barkley (2013, cited in your textbook), what additional dimensions are associated with SCT?

Daydreaming/Sleepiness* • Slow/Sluggish/Lethargic* Low Initiation/Persistence

Withdrawal

Development of substance-specific problematic behavior (physiological & cognitive) change due to the cessation of or reduction in heavy and prolonged substance use

Characterized by early age of onset and steep, escalating use of substance

Early Escalating Type

slow to warm characteristics?

Fearful or inhibited, cautious, variable in self-regulation and adaptability, and may show distress or negativity toward some situations

what is emotional factors are inherited in Childhood Onset Pathway (no CU Traits)?

High emotional reactivity to negative emotional stimuli and to others' distress

How are ADHD-C/HI vs. ADHD Primarily Inattentive similar?

Impairments in academic achievement, cognitive skills, and executive function tasks, although ADHD-C more impaired in response inhibition Both more likely to be retained (32%) or placed in special education (45% & 53%) Comparable rates of learning disabilities

There was an identifiable stressor, but the timing is off eg, it is longer than 6 months

Use other specified trauma and stressor related disorder and would give the specific reason.

secure attachment

Infants use the mother as a home base from which to explore when all is well, but seek physical comfort and consolation from her if frightened or threatened

With respect to family factors, what parenting characteristics have been associated with behavior problems?

Lack of parental involvement poor monitoring and supervision low parental warmth failure to use positive reinforcement high parental hostility the use of harsh and inconsistent discipline have been linked to the development of ODD and CD

Name the four "criteria" listed in DSM-5 for children with limited prosocial emotions.

Lack of remorse or guilt Callous-lack of empathy Unconcerned about performance Shallow or deficient affect

Characterized by onset in "emerging adulthood" (peak ages 18-25), then begins to decline in response to demands of adult roles

Late Onset type

▪ Associated w/ decreases in parental supervision when adolescents leave home, have more autonomy & independence

Late Onset type

According to your textbook, the behavioral and cognitive problems seen in ADHD are context dependent (i.e., they are apparent in some situations and not all). Name the factors that seem to affect the performance of these children for the worse.

Later in the day than earlier In more complex tasks where organizational strategies are required When restraint is demanded Under low levels of stimulation Under more variable schedules of immediate consequences in the task Under longer delay periods prior to reinforcement availability In the absence of adult supervision during task performance

Tolerance

Markedly increased dose of the substance to achieve the desired effect Markedly reduced effect when the usual dose is consumed

Difficult child

Negative affect or irritability, intense in mood; not very adaptable; poor regulation of eating, sleeping, and elimination; distress and irritability in general or when faced with novel or challenging situations

In sustained remission

No criteria has been met at any time for at least 1 year**

In early remission

No criteria has been met for at least 3 months, but less than 1 year**

___ is more defying things like hw, classroom rules, and parent rules

ODD

___ is more pushing back against authority but does not harm people, animals, etc or violated the basic rights of others.

ODD

____ is usually less severe

ODD

What additional symptoms are noted for SCT?

Often daydreams* has trouble staying awake/alert* is mentally foggy/easily confused* stares a lot* is "spacey"/mind is elsewhere* is lethargic* is underactive* is slow-moving/sluggish* doesn't process questions or explanations accurately* has a drowsy/sleepy appearance* is apathetic/withdrawn* is lost in thoughts* is slow to complete tasks and lacks initiative/has trouble sustaining effort

if do not meet full criteria for oppositional defiant disorder, conduct disorder, or intermittent explosive disorder use ____ and list the reason

Other Specified Disruptive, Impulse-Control, and Conduct Disorder

If really want to diagnose ODD and have 4 symptoms but hasn't been 6 months or 2 symptoms but its been a year and its impairing what could you give?

Other specified disruptive, impulse control and conduct disorder

criteria C?

Outbursts are not premeditated or committed to achieve a tangible object (i.e., they are impulsive and/or anger-based)

D?

Outbursts cause distress, impaired functioning, or result in financial/legal consequences

Psychological

Temperament which refers to the child's organized style of behavior that appears early in development (e.g., fussiness, fearfulness) shapes his/her approach to the environment and vice versa.

Self-regulation of affect/motivation/arousal

The ability to delay the expression of emotion and its associated motor behavior to engage in self regulation and to initiate goal directed future behavior.

Adjustment Disorder criteria

The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within three months of the onset of the stressor(s). • These symptoms or behaviors are clinically significant, as evidenced by one or both of the following: 1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation. 2. Significant impairment in social, occupational (academic), or other important areas of functioning • Does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder. • The symptoms do not represent normal bereavement. • Once the stressor (or its consequences) have terminated, symptoms do not persist for more than six months. (if not its probably not an adjustment disorder)

What is "abnormal" child development? What makes a child behavior or emotion a mental health problem?

Traditionally defined as a pattern of behavioral, cognitive, or physical symptoms associated with: • rates beyond what we would expect by age, gender, culture • intensity above or below what is defined as developmentally appropriate • failure to develop regulatory mechanisms or master developmental tasks • use of problematic coping skills (e.g., rituals, dissociation) to compensate for regulatory problems or traumatic experiences. This could perpetuate the mental health problem • clinically-significant distress • impairment (disability), or inability to function in appropriate roles • increased risk for further suffering or harm • You need to compare children to kids that are in their peer group to determine if their behavior is abnormal

Withdrawal

The same (or closely related) substance is taken to relieve/avoid withdrawal symptoms

Information Processing theories

The way children process information (e.g., attend, encode, interpret, and remember it) can shape how the child behaviorally responds to the world.

Emotional perspective

There is growing support for the view that emotionality and regulation are related to children's concurrent and long term social competence and adjustment. Emotions tell us what to attend to, what to approach or avoid, & provide motivation for action; they send messages to us and others about our current state and connect us to each other

Briefly describe the dimensional approach to developmental psychopathology proposed by Hudziak et al. 2007. What benefit, if any, would this approach provide the current taxonomy used to classify psychiatric disorders?

These profiles present psychopathology in terms that are both sensitive and specific in relation to gender and age variance. Dimensional approaches offer many advantages for neuroscience and Page 13 of 34 genomics. It has been argued that we may identify continua for some kinds of psychopathology and categories for other kinds. For these reasons, we have argued for a complementary system that includes both approaches. For these reasons, we have argued for a complementary system that includes both approaches. We note that dimensional approaches are needed in order to inculcate potentially useful endophenotypic and genetic discoveries into our assessment procedures and that our taxonomy should facilitate rather than impede the advance of knowledge. Dimensional approaches are thus needed to characterize psychopathologies, to search for their underlying genetic and neural mechanisms, and to discover treatments and cures. The expression psychopathology in general and child psychopathology in particular, is affected by multiple sources of variance. Some of these sources include gender differences, informant differences, and age-related differences. In this paper, we discuss how these sources of variance complicate both research and clinical management. We argue that the current diagnostic system would be aided by the inclusion of a quantitative axis that can take these sources of variance into account. We reason that the fields of genomics and neuroscience are prepared to move the field of developmental psychopathology forward, but need a diagnostic system that allows for these sources of variance to be controlled. We demonstrate how in Conduct Disorder, inclusion of dimensional information would allow the clinician or researcher to demonstrate not only the presence or absence of pathology, but also the degree to which the disorder is manifested in a particular individual.

Cognitive behavioral theory:

This asserts that maladaptive cognitive processes predispose children to psychopathology and maintain symptoms once they occur

Neurobiological (biological) perspective

This perspective considers brain and nervous system functions as underlying causes of psychological disorders. Remember that these biological influences interact with the environment to produce behavior. Different areas of the brain regulate different functions and behaviors. When specific areas of the brain are underdeveloped or become damaged, we see deficits in the behaviors regulated by that area

o For the childhood- onset type without CU traits, conduct problems are viewed as resulting from an interaction between ____ and ____. This interaction disrupts the socialization of the child and leads to enduring vulnerabilities and adjustment problems across the lifespan (Patterson, 1996).

a child's risky temperament (e.g., impulsivity, poorly regulated emotions) exposure to a problematic socializing environment (e.g., ineffective parental discipline)

disorganized attachment

a type of attachment that is marked by an infant's inconsistent reactions to the caregiver's departure and return

Working memory (Non-verbal working memory)

ability to hold events in mind and use that information to guide your response (hindsight and foresight)

Behavioral inhibition

ability to withhold or delay a response and/or protect oneself from competing events or responses.

Youth in the ____-onset group have more deviant peer associations than youth in the ___-onset group.

adolescent childhood

______ path begins around puberty and declines in young adulthood (more common and less serious than LCP)

adolescent-limited (AL)

Hostile (negative) attribution bias lead to

aggression

ODD, unlike conduct disorder, does not include

aggression toward people or animals destruction of property a pattern of theft or deceit

anxious-resistant attachment

an insecure attachment between infant and caregiver, characterized by distress at separation and anger at reunion

anxious-avoidant attachment

an insecure attachment between infant and caregiver, characterized by indifference on the part of the infant toward the caregiver

cognitive

beliefs

Adolescent-limited path is not "___".

benign

Academic Achievement?

both ADHD/C and ADHD/I groups have been found to perform more poorly than normal control groups Studies exam- ining differences between ADHD groups offer mixed results. Several studies have found no differences between groups on tests of academic achievement Barkley et al. found that equal percentages of ADD/H (31.7%) and ADD/WO (31.9%) children were held back at least once in school, but significantly more of the ADD/WO children had a school placement of learning disabled. In contrast, 15% of the ADD/H and none of the ADD/WO were suspended from school at least once, and the former (12%) were sig- nificantly more likely than the latter (0%) to receive a behavior disorders school placement. However, Lahey, Schaughency, Frame, and Strauss (1984) used teacher ratings to assess academic achievement and found that normal control children were rated higher in academic achievement than ADD/H children, who in turn were rated higher than ADD/WO children. Both ADHD/ C and ADHD/I subtypes have been associated with ele- vated rates of learning disorders. found that ADHD/C children were more likely than ADHD/I children to have a co-diagnosis of language/ stuttering disorders, but no differences in the rates of identified reading or math disabilities. ***In summary, both children with ADHD/I and ADHD/C have been found to perform more poorly on measures of academic achievement than children without ADHD, and both groups are also consistently more likely to receive some form of a learning disabilities diagnosis. Furthermore, when subtype differences are found, chil- dren with ADHD/I have been found to perform more poorly on achievement measures than children with ADHD/C, particularly on measures of math achievement This latter finding suggests that the processing deficits in the combined and inattentive groups may be qualitatively different, with the inattentive group perhaps showing more deficits in right hemispheric functioning.

What does Attachment theory say about child psychopathology?

child psychopathology develops when caregivers are unable to respond appropriately to a child's needs. These early attachment relationships create "internal working models" of the self and others that the child later carries into adulthood and subsequent relationships.

Individuals with the specifier are more likely to have ____ type and a specifier rating of ____

childhood-onset severe

AL CD was associated with relatively few risk factors. The primary risk factor for adolescent limited CD was association with ___

deviant peers

Difficulty processing emotions

e.g., recognizing, interpreting, and expressing emotions

Types of temperament?

easy child, slow to warm, difficult child

emotional regulation

efforts to enhance, maintain, or inhibit emotional arousal for a specific purpose or goal

oppositional defiant disorder includes problems of _____ (i.e., angry and irritable mood) that are not included in the definition of conduct disorder.

emotional dysregulation

Emotional flooding:

emotional interference with planful cognitive processes

differences in the threshold and intensity of emotional experience, which affect levels of distress and sensitivity to the environment

emotional reactivity

emotional

emotional regulation

unrestrained emotions

emotions unconnected to cognitive or affective control processes

Difficulty coordinating __ and __ to regulate emotions

emotions, cognition

three risk factors for conduct problems at the neighborhood and community level

gang membership availability of weapons Neighborhood disadvantage and poverty

instrumental gain is

goal directed

Cognitive processes

guided by schemas--refer to how the person perceives and interprets information.

In a study _____ at age 4 significantly predicted CU traits at age 13, accounting for 10% and 14% of the variance in these traits in boys and girls, respectively (Barker et al., 2011). In the few longitudinal studies that have tested potential bidirectional effects of parenting and child characteristics, CU traits have been more predictive of changes in parenting over time than parenting has been predictive of changes in CU traits over time (Hawes, Dadds, Frost, & Hasking, 2011; Muñoz, Pakalniskiene, & Frick, 2011).

harsh parenting

Individuals with characteristics described in this specifier may be more likely than other individuals with conduct disorder to engage in aggression that is planned for ____ gain.

instrumental

•ADHD is not an ____ defiance against authority

intentional

Some aspects of abnormal development are ___ which means that there are some aspects that depend on each other

interdependent

specify whether means

it is required!! need this for adjustment disorder

Predominantly Hyperactive-Impulsive & Combined characteristics

more oppositional and aggressive symptoms greater co-morbidity w/ ODD and CD more peer rejection more speech & language problems more problems w/ motor inhibition, sequencing & planning described as "noisy, disruptive, messy, irresponsible, and immature" (contrast w/ PI) higher rates of placement in classes for children w/ behavioral disturbances

•similar pathways lead to different outcomes

multifinality eg, All experienced maltreatment. Some develop eating disorders. Others conduct disorder. Some fine

Abnormal development is ___ determined, with risk and protective factors operating on multiple levels

multiply

What two types of standardized measures should be included as part of an intake assessment for mental health problems?

o Broad Band Mental Health Measure- any measure that covers a lot of different disorders o Measure specific to presenting problem

Leads to "snares" which can cause long term impairment

o CD: Adolescent Onset Pathway

Less gender differences

o CD: Adolescent Onset Pathway

Not associated with as much persistence, severity, or vulnerability

o CD: Adolescent Onset Pathway

Many child behavior problems are simply an extension of children's "normal" behaviors and experiences (for example, normal childhood fears vs. an anxiety disorder). What considerations must be taken into account when making judgments about abnormal behavior?

o Compared to their peer group o If it causes harm or deprivation of benefit to the child as judged by social norms o If it results from the failure of some internal mechanism to perform its natural functions (Ex. Executive functions in the context of self-regulation

• Why is it important to understand the strengths and competencies of children and family members in treatment? Name two reasons.

o Help inform your treatment plan o build rapport

• Define co-morbidity.

o Psychological disorders can occur simultaneously.

what are some aggressive children not so good at doing?

o Step 1: Encoding- taking in information from environment/event Step 2: Interpretation- assessing the information that was gathered and forming conclusion o Step 3: Response Search- generating list of possible responses to event Step 4: Response Decision- choosing response to act out, from list of possible responses o Step 5: Enactment- acting out chosen response

What is "reversal learning"?

o changing a previously rewarded behavior following a change to punishment

CU traits were associated with two polymorphisms on the ___ receptor (OXTR) gene which plays a role in affiliation and recognition of others' emotions, both of which are impaired in individuals with CU traits.

oxytocin

three risk factors for conduct problems at the school level

poor academic functioning low educational aspirations weak bonding to school

easy child characteristics?

positive affect, approachable, adaptable to environment, exhibits regular patterns of eating, sleeping, and elimination

ODD often ____ CD (age of onset 6 vs. 9)

precedes

Executive functions

private, cognitive abilities, or skills that guide goal directed, future oriented, and intentional actions that lead to positive outcomes.

This group seems to show a distinct temperamental style that places them at risk for missing some of the early precursors to empathic concern, and that may make these children relatively insensitive to the ___ and ____ of parents and other socializing agents

prohibitions sanctions

protective factor

protective factors are variables that precede a (potential) negative outcome and decrease the chances that the outcome will occur, despite the presence of risk

The limited prosocial emotions specifier puts kids on a more ___ trajectory. It shows a relatively ___ form of the disorder. Its ____ responsive to treatment because if you think about behavioral treatments we have, they have to care about getting rewards, getting punished and pleasing others. They are more likely to use _____ in a premeditated way and for ____ gain (get something from you). Can have any onset or severity rating but it is more common to see a childhood onset and a severe form of the disorder.

risky severe less aggression instrumental

you have an identifiable stressor, but not sure its related to symptoms

say other specified and then name the neighborhood. Also have to list why you don't meet criteria

Youth with CU traits show a particularly ___, ___, and ____ pattern of conduct problems.

severe stable aggressive

all the symptoms listed except _____ is more likely to have SCT over ADHD

slow to complete tasks and lacks initiative/has trouble sustaining effort

Some aggressive children are not so good at ____ down their thinking to be able to gather sufficient and relevant information about an event, to be able to then come up with reasonable response options to that event (usually only think of aggressive ones).

slowing

DO NOT FORGET TO PUT THE ____ FOR ADJUSTMENT DISORDER

specifier

They have as many friends as other adolescents, but friendships are less ___ and viewed as more conflictual by youth scoring high on CU traits

stable

Adjustment Disorder with Disturbance in Conduct vs ODD/CD, need a ___ to trigger it

stressor

comorbid externalizing problems?

the lit- erature is quite consistent in documenting that the ADHD/C group is associated with higher rates of con- duct disorder and oppositional defiant disorder compared with the ADHD/I group Similarly, many studies have found higher rates of CD and ODD among ADD/H children compared with ADD/WO children elevated rates of internalizing disorders often have been found in both ADHD/I and ADHD/C groups In contrast, there have been at least three studies that have found differences between ADHD/C and ADHD/I in rates of comorbid internalizing disorders. Lahey et al. (1987) found that children with ADD/WO (43%) were more likely than children with ADD/H (10%) to have a comorbid internalizing disorder Finally, Faraone et al. (1998) report a somewhat controversial finding (see Stein, Roizen, & Leventhal, 1999): the combined group had a higher rate of comorbid bipolar disorder (26.5%) than the inattentive group (8.7%). ***In summary, the literature regarding the presence of comorbid disorders in the combined and inattentive groups is clear in documenting important differences in terms of the externalizing problems of conduct disorder and oppositional defiant disorder ***The results concerning internalizing problems are less clear cut, with some sug- gestion that these problems may be more evident in the inattentive group, although the majority of studies fail to find such differences

cognitive products

the thoughts that result from cognitive processes (e.g., cognitive distortions).

Cognitive structures

the way information is organized and stored in memory, also serve to filter current experiences

behavioral

what is he doing?

In sum

when behavioral inhibition is compromised, the executive functions cannot do their job in regulating motor control. As a result, the child can not perform responses that would help them attain their goal.

Youth with CU traits are labeled as what in the DSM-5?

with limited prosocial emotions

Lack of remorse or guilt

• Does not feel bad or guilty when they do something wrong. Exclude remorse when the person is caught/ facing punishment. General lack of concern about the negative consequence of their actions. Does not care about hurting someone and does not care about the consequences of breaking the rules.

▪ Unconcerned about performance

• Does not show concern about problematic performance in school or work • Does not put effort in performances • Blames others for their poor performance

▪ Shallow or deficient affect

• Doesn't express feelings or show emotions to others unless its in ways that seem shallow, insincere, and superficial • Actions can contradict the emotion displayed • Can turn emotions on or off quickly • Doesn't count when emotional expression is used for gain

resilience

•successful adaptation in children who experience significant adversity (e.g., avoid negative outcomes) or achieve positive outcomes despite risk

•Risk Factors:

•variables that precede a negative outcome and increase the chances that the outcome will occur

CD: Childhood Onset Pathway (with CU Traits)

▪ A minority of the childhood onset group ▪ Severe, stable, aggressive pattern

what cognitive factors are inherited in CD-Childhood Onset Pathway (General)?

▪ Deficits in executive functioning and low verbal intelligence

what is cogntive factors are inherited in CD-Adolescent Onset Pathway?

▪ Less traditional values, more rebellious & autonomy-seeking

what are three potential advantages to labeling kids?

▪ Provides Access to Rights/Protections ▪ Common Language & Understanding of the Problem ▪ Some Structure, Recognition, and Clarity for Families

____ path begins at an early age and persists into adulthood. More likely to develop anti social personality disorder

▪ life-course-persistent (LCP)

three risk factors for conduct problems at the sociocultural level

▪ media portrayal of violence ▪ cultural attitudes encouraging the use of aggression ▪ socialization of children for aggression

what are three potential disadvantages?

▪When is it about the context and not the child? ▪ "Singling Out", Stigmatizing, Labeling Children ▪ Disagreements as to Best Classification System