fidgets, difficultly playing with others, on the go, talks excessively, blruts out answers

-onset is early childhood 

-There must be clinically significant impairment in academic, social, or occupational functioning

Academic impairment: learning disabilities, much slower work, more likely to drop out of school/expelled 

-Social and emotional: more likely to be ignored, fewer friends, low self-esteem

Adaptive: Overall impairment: less mature, family stress, more accidents 

Academic: lower GPA, drop out rates high

-Social: fewer friends, depression

Occupational: more likely to be fired or switch jobs

Adaptive: more traffic accidents, less healthy, elevated rates of substance abuse 

Is valid but only if it is diagnosed validly

A diagnosis should not be made off: 5 min discussion with pediatrician, based on a report of a single distressed individual, because it sounds less scary, over diagnosis

-The highest percentages of those who have ADHD are high SES

-It is both under and over diagnosed

-Genetic influences: all known genetic risk factors is only 5%

-Highly heritable, 100s of genes involved

Environmental: smoking during pregnancy, hypoxia and other birth complications, environmental lead

-genetic variance is 5%

-performance below expected levels, IQ, education, age

-Actual vs expected achievement is critical aspect 

-cannot be due to sensory deficits

-involves reading, math, or writing disorder 

-higher drop out rates, negative school experience 

-language, socialization, and cognitive problems 

-significant impairment across lifespan

-examples: Autism, Aspergers

-impairment in social interactions, relative to age few friends, joint attention problems, social awareness

-communication problems, 1/3 never can talk 

-conversational impairments 

-onset age 3 

-IQ less than 35 

repeated vocal patterns

-normal during age 6-9 months 

ritualistic behaviors

-goes with autism 

-5-10% risk of second child 

-early dectection important

-·      Amygdala: larger size at birth=higher anxiety and fear, fewer neurons

 -·      50 to 200 fold increase in risk, Oxytocin receptor genes, Bonding and Social memory

social impairments, more verbal than autism

-more common than we think, more boys than girls

-no severe delays

·      treatment: build skill set increase socialization, reduce problem behaviors, integrated treatment works best 

-key feature in differences between autism and aspergers: no language delay in aspergers

-below average functioning 

-measured by standarized testing 

IQ of 70 or below

-Adaptive problems

-present before age 18 

-based on assistance required: intermitten, limited, extensive, pervasive 

-mild=50-55

-moderate=35-40

-severe=20-25

-profound=below 20-25 

-prenatal=exposure to virus,drug, toxin

-perinatal=labor complications

-postnatal=head injury, infection, toxic exposure 

-PKU

-X linked, males 

-trisomy 21 

-risk increases with maternal age 

-skill instruction, education, behavior management 

-living and self care

-communication training 

-early intervention

-genetic screening 

Personality Disorders 

(how do we differentiate abnormal personality from normal)

-when extreme traits casue distress 

-long standing pervasive, inflexible patterns of behavior 

-not consistent with cultural expectations

-casue emtional distress

-3 clusters 

-high comorbidity with axis 1 disoders, poorer prognosis 

-odd eccentirc

-paranoid, schizoid, schizotypal 

-pervasive/ unjustified 

-few meaningful realtionships

-volatile, tense 

-sensitive to criticism 

-dramaric, emotional, erratic 

-Antisocial, borderline, histronic, narcissistic 

-fearful/ anxious 

-avoidant, dependent, obsessive-complusive 

-possible relation to schizophrenia

-possible role of early experience

-trauma, abuse, learning, "the world is dangerous"

-unlikely to seek treament on own

-focus on developing trust 

-nocompliance with social norms

-"social predators" 

-violate rights of others

-irresponsible 

-inmplusive

-deceitful

-lack conscience, empathy and remorse 

-glibness/superficial charm 

-grandiose sense of worth 

-prone to boredom/need for stimulation

-pathological lying

-conning/manipulative

-lack of remorse

-overlap with ASPD, criminality

board room psychopath 

Cluster B

(family history)

-inconsistent parental discipline

-variable support

-criminality

-violence 

-early history of behavior problems 

-Gene-envirnoment interaction 

-gentic predisposition

-envirnomental triggers

-Arousal hypothese

-underarousal/fearlessness 

-alienation from good role models

-poor occupational/social function 

-reinforcement 

-behavioral inhibition system(BIS) is low 

-reward system (REW) is high

-Fight/Flight(F/F)

-cause of antisocial personaility 

-unlikely to seek on own

-high recideivism 

-incarceration 

-early intervention 

-parent training 

-prevention 

-rewards for pro social behaviors 

-skill training 

-improve social competence 

-instability 

-labile, intense moods

-turbulent relationships 

-implusivity -fear of abandonment 

-very poor self image 

-self mutilation 

-suicidal gestures 

-combormid with depression, suicide, bipolar, substance abuse , eating disorders 

-genetic/biological components 

-serotoin

-limbic circit

-early childhood expireneces 

-neglect, trama, abuse 

-overly dramatic, sensational, sexually provoative, implusive, attention seeking, apperance focused, impressionistic, vague, superficial speech 

-more common in females 

Exaggerated and unreasonable sense of self importance 

-require atention

-lack of sensitivity and compassion

-sensitve to criticism 

-Envious 

-Arrogant 

Cluster B: Narcissistic 

(causes) 

-deficits in early cildhood learning 

-alturism 

-empathy 

-incrased individual focus 

-"Me generation" 

-Treatment focuses on : 

-Grandiosity, lack of empathy 

hypersensitvity to evluationn 

-Co-occuring depression 

-little empirical support 

-extreme sensivity to opinions 

-avoid most reaktionships

-interpersonally anxious 

-fearful of rejection 

-Early parental rejection 

-Interpersonal isolation and conflict 

-treatment: similar to social phobia, increase social skills, reduce anxiety

-Rely on others for major and minor decisions

-unreasonable fear of abondoment 

-Clingy 

-Submissive 

-Timid

-Passive

-Feelings of inadequacy 

-sensitive to criticism, high need for reassurance 

-death of parent 

-rejection 

-Attachment 

-Caution:dependence on therapist

-Gradual increases in: independence, personal responsiblity,confidence 

-fixation on doing things "the right way" 

-rigid, perfectionistc 

-orderly, preoccupied with details, poor interpersonal relationships

-obessions and complusions are rare 

-adress fears related to need for orderliness

-decrease: Rumination, Procrastiantion, and feelings of inadequacy 

-3 classes of Cognitive Disorders 

1. Delirium 

3 classes CD

Dementia 

3 Classes CD 

Amnestic 

-DSM changes 

-"organic" vs neurocognitive disorders 

-bad cognitive impairments 

-memory

-attention 

-preception, thinking

-Profound changes(Behavior/ Personality )

Global impairments 

-consciousness

-cognition

-develop rapidly 

-several hours 

-days 

-emaples: confusion, disorientation, attention, memory, and language deficits 

-10-30% in actue care (ER)

-Highest Prevelance: Older adults, AIDS patients, medical Patients 

-Full recovery=several weeks 

-develops rapidly 

-drug intoxication 

-medications

-Illicit drugs (MDMA)

-Posions

-Withdraw from drugs 

-Fever, INfections, head injury, sleep deprivation, immobility, excessive stress 

-treat underlying medical problems 

-Psychosocial interventions: education, reassurances, coping strategies 

Prevention: proper medical care and medication 

-Gradual deterioraton of brian functions 

-Affects multiple domains, Judgement, memory, language 

-Advanced cognitive processes 

-More gradual than dilirum 

-may or may not be reverislbe 

-memory impariments 

-Agnosia: inability to recognize things 

-Facil agnois 

-delusions 

-depression 

-agitation

-arrgession 

-apathy 

-contiuned cognitive decline 

-assistnace with activities of daily living 

death=inactivity+other ilness 

20-40% over the age of 85 

-rate doubble with every 5 years of age 

-Alzheimer's in centneairans=100%?

-women>men 

-longer lifespan 

-slowing progression 

-Alzheimer's type

-Vascular

-Substance induced  

-develop gradulaly and steadily

-confusion 

-agitaion/combativness 

-depression 

-anxiety

-Sundowner sundrome: worse at the end of the day 

-aphaisa:difficulty with language 

-Apraxia:difficulty with motor function 

-Agnosia; Difficulty recognizing objects 

-excutive function, planning, organizing, sequencing 

-Significant social and occuational impairments 

-Definitive diagnosis=Autopsy 

-70-90% accurate while alive 

Alzheimer's Disease 

Stats

onset 60s or 70s

more common in women 

post diagnosis survival=8yrs 

-lower prevelance in highly educated 

-American Indians less likely 

-Higher in less eduated 

-gentics 

-progressive brain disorder 

-Blockage or dmage to blood vessels 

-onset is often sudden 

-stroke 

-variable impairments 

-greater motor problmes 

-weakness in limbs 

-identical to ALzheirms 

-men>women

-higher rates cardiovascualr disease 

-most will require formal nursing care 

-death from infection=Pneumnia, weak immune system 

-Accidents most common cause 

-memory loss is primary sympotm 

-Additive efects 

-Chronic Traumaitc Encephalopthy (CTE)

-motor problmes

-tremors

-walking, speaking

-not all with PD will develop dementia 

-Drug use +poor diet 

-brain damage can be permanent 

-symptoms similar to Alzheimer's 

-susceptibilty genes: apoE-2,apoE-3, apoE-4

-Chromosome 19 

-Lifestyle factors: drug use, diet, exercise, stress

-head injury 

-early intervention is crucial 

-three areas: prevention, delaying, management 

-focus on slowing progession 

-antioxidants: vitamin E, asprins 

-all meds are only efectively for short periods 

-stresstful life circumsatances

-long standing problmes 

-seeking personal growth 

-wokring collaborativly work as team 

-p and t agreement on goals

-good supportive bond 

-clients's motivation to change 

-clients expectation to change 

-client's view of therapy good interpersonal match 

-threapist impression/ clients impression 

family reports 

-objective measures 

-comparison of pretreatment and post treatment scores  

-measurable behaviors 

-severe pathology to remain unhospotalized should use meds 

-problems with medications include side effects 

-relapse can also sometimes occur because sympotms are reduced but disorder is not cured 

-efficacy is detemined bia randomized clinical trials in which threapy is compared to placebo 

-usually double blind 

-typically manualized to contorl variabliity between therapists 

-if effiecacy studies determine that therapy work it is described as evidence based 

-increased acitivation, more rewarding life, fewer problems 

-goal: recovery and protection from depression **

-theory is based on functional analysis 

(establish function of a behavior: identify motivation, trigger, behavior and consequence 

-encourgages engagment with life/directed towards specific symptoms 

best with problems  that are not pervasive (better for axis 1 )

-decrease engagment in activities that maitain or increase dpression 

-increase engagement in adaptive activities 

-solve problems that limit acces to reward or that maintain abersive controls 

-all contribute to major goal of threapy; recovery and protection 

Establish and follow agenda 

Nurtures Activation 

Learns together 

Is non judgmental (same level with t and c ) 

Validates 

Encourages 

Naturally expresses warmth 

-monitor depression 

-set collaborative agenda 

-follow agenda 

-check in about the time since last session 

-review and assign homework 

-orient client and ask for feedback on how client felt session went 

Overall goal of BA treatment 

Antidepressant/UP Activities 

(specific behaviors increase) 

depressant/down 

(specific behaviors to decrease) 

A common challenge during BA tx

(Rumination) 

R: mental activity, repetitve, concontrollable thoughts, distressing to the person 

to decrease R: discuss and explore consequences of ruminating 

problme solving instead

direct attention to sensations currently present in the body 

-distract-engage in something mentally of physically active (working out, something social )

review things the client has learned during therapy 

-◦What situations in client’s life tend to increase depression?

RCT have shown strong effect of BA should be considered a good treatment for medication 

has been found to be more efefctive than Cognitive therapy 

-has been found to be as effective as antidepressant medication 

-developed by Marsha LInehan 

-treatment designed for para-suicidal behavior(suicidal behavior tha t probably wont end in death), also treatment for drug abuse and dissoviative disorders 

-involves indivual therapy  combined with DBT skills training in a group 

-patients are thought how to better regulate their emotions 

-problem solving is emphasized 

-practice skills learned in skills group

-in later stages DBT patients are taught to trust their own responses rather than depend on validation of others 

ERP

Exposure and Response Prevention 

-used to treat anxiety, OCD

-a therapeutic effect will occur when clients cconfront hteir fears

-Client identifies thier fears and rans them mildest to most sever 

-therapist works with client to tackel the least frightening thing then more challenging

-client experiences habituation on feared stimulus

-client also practices a fear-incompatiable behavroal response to the stimulus 

-typically causes some short term anxiety, but facillitates long term reduction in both obsessive and compulsive behaviors 

-in order for it to work client must refrain from escape response and is to be maintained at all times and not just during practice sessions, they have to practice at home 

-addresses dysfunctional emotions, maladptive behavior and cognitive processes, goal oriented, explicit systematic procedures, created by Beck 

-attempts to change a person's behavior by modifying self-statementsand construal of eventes, automatic thoughts(identify and replace*)

-based on the assumption that problems like depression result from clients illogical thinking about themselves/world around them 

-focuses on examining relationship between thoughts, feelings, and behaviors

-by exploring patterns of thinking that lead to self destructive actions and belifes that direct these thoughts, people can modify their patterns of thinking to improve coping 

-can be applied to many people 

-focus on here and now/, not past issues sessions are highly structured/limited # of sessions 

-directive, guiding role of therapist

-therapsit must be problem focued and goal oriented 

-it is an active intervention so homework and practice outside of sessions 

-effective in treating anxiety/ bulimia 

-debate about wheter cognitve change is the "active ingredient"in cognitve therapy 

-it may be the behavioral component that is responisble for effectiveness of therapy 

-most effective in addition to medication for serious disorders, like bipolar 

-combines CBT and mindfulness practices 

-designed to help people who suffer repeated bouts of depression and chronic unhappiness 

-focus on becoming aware of all of one's thoughts and feelings and accepting them, but not automatically reacting to them

-Theory states that when people with a history of major depression experience life stress or distress, they can often return to automatic cognitve processes that are likely to lead to another depressive episode 

MBCT continued 

-goal is to interrupt automatice processes that lead to distress and teach clients to focus less on reacting to incoming stimuli but instead accept and observe without being judgemental

-MBCT prioritizes learning how to concentrate with purpose and be in the moment 

-clients are taught to recognize that holding onto certain cognitions and emotions can be ineffective and mentally destructive 

-Guidance: ethical/ state and federal laws 

-The issues: civil vs criminal commitment, ethical vs legal considerations , practice standards, mental health care evolution 

-Civil Commitment laws: 

-legal declaration of mental illness -involuntary commitment

-involuntary treatment/laws and defintions vary by state 

person: mentally ill & needs treatment 

-dangerous to self or others 

-gravely disabled 

-inability to care for self 

Civil Commitment 

(Governmental Authority) 

-POlice power 

-Health, welfare, saftey of society 

-Parens patriae: state acts as a surrogate parent 

-Intial Stages: Person fails to seek help/others feel help is needed/petition is made to judge/indivdual must be notified 

Subsequent Stages: involves normal legal proceedings/should person be commited? judge makes determination 

Civil Commitment 

(role of mental health professionals) 

-can identify groups at increased risk 

-previous history of violence 

-alcohol dependence 

-cannot make specific predictions about violence 

-Supreme Court

-restrictions on involuntary commitment

-insufficient grounds: non dangerous person, need for treatment alone, gravely disabled 

-criminalization of the mentally ill

-deinstituonalization and homelessness 

-traninstitutionalization 

-Public outrage: several cases found NGRI( not guilty by reason of insanity), John Hinckley Jr, Charles Mason, Ted Kaczynski 

public perceptions: legal loophole, overused 

-thought he could turn victims into eternal sex zombies 

-drilled holes into skull injected acid and boling water 

-victims usually alive 

-disposed of bodies with acid vat 

-found sane and guilty sentenced to 15 life sentences, beaten to death in prison 

facts: <1% of felony cases

time in mental hospitals>jail 

Changes: insanity defense reform act 

M'Naughten-like 

-Gulity but mentally ill (GBMI): allows for treatment and punishment 

requirements: understand legal charges, ability to assist in defense, essential for legal processes, burden of proof=defense 

consequences: loss of decision-making authority, results in commitment, limitations 

Mental Health Professionals as Expert Witnesses 

(psychologists' role) 

-specialized knowledge and expertise

-competency determinations: assess risk, reliable DSM diagnoses, Advise the court

-psychological assessment 

-diagnosis 

-assess malingering 

the right to treatment: must treat if involuntarily committed, reduce symptoms, provide humane, least confining and limiting setting 

-the right to refuse treatment: medical or drug treatment, cannot be force competence to stand trail 

-right to be informed about the research ; informed consent 

-right to privacy -right to be treated with respect and dignity - right to be protected from physical and mental harm - right to chose or refuse to participate in research

-right to anonymity

-right to safeguarding records  

effective health care practices: empirrical support, systematic, replicable 

rationale and goals: decrease costs, improve outcomes