• Sustained: focus on something for a period of time
• Selective: focus on what you want to focus on
• Adaptive: realize when it is best to use one strategy over another adaptively

·         Increases sharply between 2 and 3.5 years, may be due to a variety of changes at this age: 

•  Frontal lobe growth: more inhibition
•   More complex play goals:kids learn during play
•   Adult scaffolding

• Production deficiency
• Control deficiency
• utilizationd eficiency: performance problem
• Effective strategy usse

• 6 or more inattentive symptoms OR hyperactivity-impulsiviy symptoms
• persistent for 6 months
• maladaptive & inconsistent w/ developmen
• Symptoms present before age 7
• impairment from symptoms in 2 or more settings
• clinically significant impairment in social, academic, or occupational functioning
• Symptoms don't occur exclusively during and arent better accounted for by other disorders 

1. no close attention to details, makes careless mistakes
2. difficulty sustaining attention in tasks or play
3. doesn't seem to listen when spoken to directly
4. doesn't follow through on instructions or finish schoolwork/chores/work duties (not due to opposition or failure to understand)
5. difficulty organizing tasks & activities
6. avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort (schoolwork)
7. loses things necessary for tasks
8. easily distracted by extraneous stimuli
9. forgetful in daily activities

1. fidges w/ hands or feet or squirms in seat
2. leaves seat in class or places remaining seated is expected
3. runs aorund or climbs excessivily in inappropriate situations
4. difficulty playing or doing in leasure activities quietly
5. often "on the go" as if "driven by a motor"
6. talks excessively 

1. blurts out answers before question is complete
2. difficulty waiting turn
3. interrupts or intrudes on others

1. Cognitive impairments (7-10pts lower)
2. Language (35% delayed onset)
3. Adaptive functioning (10-30pts lower)
4. motor development (52% delayed coordination)
5. emotion (poor self-regulation)
6. school performance (30% repeat a grade)
7. task performance (e.g. poor persistance)
8. medical/health risks (57% greater proneness to accidents)

• growth: loss of 1cm/yr, younger can be 1.4cm/yr
• nervousness
• insomnia
• Blood pressure/pulse change
• loss of appetite
• more aggression and irritability

• Performance is worse:
• later in the day
• with greater task complexity
• when restraint is demanded
• under low levels of stimulation
• under variable schedules of immediate consequences
• under long delays to reinfrocement
• in absence of adult supervision

• PMT: parent management training
• CBT (better for comorbid internalizing disorder)
• Social Skills Training
• Meds (better for comorbid externalizing disorder)

New way to diagnose based on the base rates in the general population and your specific clinic

-must have good assessment/instruments

-provides incremental validity for each new piece of information

likelihood ratios are used for assessing the value of performing a diagnostic test. They use the sensitivity and specificity of the test to determine whether a test result usefully changes the probability that a condition (such as a disease state) exists. (wikipedia)

• Biological: evolutionary, genetic heritage
• social learning: modeling moral behavior
• behaviorist: rewards & punishments
• cognitive-developmental: children as active thinkers about social rules

1. build mutually respectful bond
2. let child know how to act (ahead of time)
3. praise mature behavior

• Heteronomous morality (5-10yrs)
• view rules as handed down, permanent, unchangeable, requiring strict obedience
• judge wrongness by outcomes not intentions
• Autonomous morality (10+ years)
• rules as socailly-agreed on, changeable, ideal reciprocity
• judge on outcomes and itentions

• preconvention level 
• really concrete, externally controlled
• right & wrong/ punishment & obedience
• instrumental purpose
• conventional level 
• ensure relationship/social order
• goodboy-good girl (morality of interpersonal cooperation)
• social order maintaining
• Postconventional level
• abstract princples/values
• social contract, rules are flexible
• universal ethical principle- right determined by self-chosen principles
• respect of dignity and worth

• Kohlberg said morals are rights and justice oriented
• Gilligan said it was caring for others orientation (ethics of care)

moral imperatives (protect rights/welfare)

-victimes and other kids react strongle to moral offences

-adults explain rights and feelings of victims

social conventions (customs by consensus) 

-e.g. table manners, "god bless you"

-peers seldom react to violations

-adults explain less, demand obedience

Distributive justice

-stages

Not only what is right but what is fair

• Equality (5-6 yrs): everyone gets the same thing
• Merit (6-7yrs): everyone gets amount based on what they put in
• Benevolence (8+yrs): justification for merit, was somebody able to contribute 

• Early & Middle childhood
• Instrumental (for reinforcement) aggression declines but hostile (because of anger) aggression increases
• boys more physically aggressive girls more relationally aggressive
• Adolescense
• less aggression, more delinquency (peaks in mid adolescence)
• Individual differences in aggression are lasting

• pattern of negativistic, hostile, and defiant behavior lasting 6 months where 4 symptoms are present
• more frequenty then typical development
• sig impairment in social, academic, or occupational functioning
• doesnt occur exclusiving during psychotic or mood disorder
• criteria not met for CD and if 18 or older not met for Antisocial Personality Disorder

1. often loses temper
2. often argues with adults
3. actively defies or refuses to comply w/ adults' requests or rules
4. deliberately annoys people
5. blames others for his mistakes/misbehavior
6. touchy or easily annoyed by others
7. angry or resentful
8. spiteful or vindictive

• repetitive and persistent pattern of behavior where basic rights of others or major age-appropriate societal norms or rules are violated shown by 3 or more of following criteria in past 12 months and at least one present in past 6 months
• significatn impairment in social, academic, or occupational functioning, 
• individual is age 18 or older, criteria not met for antisocial personality disorder

• Aggression to people an animals
• destruction of property
• deceitfulness or theft
• serious violations of rules

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. brick, bat, gun)
4. has been physically cruel to people
5. has been physically cruel to animals
6. stolen while confronting a victim (mugging)
7. forced someone into sexual activity

1. deliberately engaged in fire setting with intentions of causing serious damage
2. deliberately destroyed others' property

1. has broken into someone else's house, building, or car
2. often lies to obtain goods or favors or avoid obligations
3. has stolen items of nontrivial value without confronting a victim (shoplifting)

1. often stays out at night despite parental prohibition, beginning before 13 years
2. has run away from home overnight at least twice while living in parental or parental surrogate home
3. often truant from school, beginning before age 13

ODD=refusal to comply

CD=violations of the rights of others, often involves the legal system

-early onset is worse

-ADHD influencdes development, couse, & severity of CD

-ADHD path to CD is usually through ODD

Very different things

-psychopathy involves callous, manipulative, impulsive, predatory, remorseless behavior over and above antisocial deviant behavior

33% of ODD go on to have CD and 33% of these go on to have antisocial personality disorder

Over 90% of children w/ CD have had ODD but not the same reversed

Overal prevelance: 3% for ODD and 5.5% for CD

equifinality: multiple things can start a disorder

multifinality: the same start can result in different disorders 

(reasons why the prevelance rates don't map on to the 33% that move from one disorder to another)

Parent-child relational problem DSM code

• cateogry should be usd when focus of clnical attention is a pattern between parent & child associated w/ clinically significant impairment in indiivdual or family functioning or development of significant symptoms in parent or child
• Doesn't talk about function of the behavior

• non-compliance
• modulation of affective states
• executive dysfunction
• language impairment
• problem-solving skills

• lower IQ scores
• being more sensitive to reward than punishment
• deficits in social codnition
• calllous or being unemotional (young children)

Proactive vs. Reactive vs. Relational

Overt vs. Covert

Destructive vs. Non destructive

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Iatrogenic- the treatment causing the symptom or disorder

Expect Pseudo Iatrogenic effects of treatment with ODD/CD (because parents are attending to behavior from therapy they notice more inappropriate behavior)

-if you start having them take data they notice it more

Iatrogenic effect can also come from preparation/warning them of their child's symptoms

Model where the parent effects the child and the child effects the parent 

-e.g. kid is acting up->mom gets frustrated -> mom does not provide good discipline -> kid acts up more -> kid gets more frustrated.. etc.

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• Negative effects of underprivileged increase the longer it lasts
• Chain reaction: e.g. Low SES-malnutrition-bad school-home problems- hard to concentrate
• Early cognitive deficits lead to more deficits (deficit compared to peers increases)
• The longer these things go on the harder it is to overcome

• communication styles
• culture-specific content
• stereotypes 

ID is relatively stable but is affected by level of impairment

Dual dianosis: ID and some other condition (comorbidity)

-Initially held back by psychoanalytic/dynamic

-problems w/ prevelance (some disorders are 4 times higher than in general population)

-likely judged more intellectually impaired

organic

-linked to 1/3-1/2 of cases

-NOT a single entity

e.g. downs, fragile-x, prader-willi

cultural-familial

-no apparent cause

-linked to 1/2-2/3 of cases

-typically mild MR with fewer physical/medical disabilities

• Neurological disorder
• females only
• Child appears normal for 5 months then deteriorates
• deceleration of head growth
• loss of purposeful hand movements (hand wringing)
• loss of social engagement
• poor gait
• impaired language and usually severe to profound MR

AKA heller syndrome

• Normal for 2 years 
• prior to 10 yrs loses at least 2 previously acquired skills
• expressive/receptive language
• social skills/adaptive behavior
• bowel/bladder control
• play motor skills
• Abnormalities in social interaction
• abnormalities in communication
• use of restricted/repetitive bx, interests, or activiteis

At least 6 symptoms w/ delays in 1 area prior to 3yrs

Social Interaction (at least 2 symptoms)

Communication (at least 1 symptom)

Repetitive (at elast 1 symptom)

• Eye gaze, body posture
• peer relations
• social sharing
• social/emotional reciprocity 

• delay in/lack of language
• impaired sustaining of a conversation
• echolalia/stereotyped use of language
• lack of make believe play, social imitation 

• behavior
• interests
• activities 

Wakefield

Study w/ 12 kids, study has been retracted

-kids taken from kid's party (not a good sample)

-advocating for spaced dosing of vaccinations which Wakefield had a patent for

Emotion

-definition

-what it does

-parts

Def: rapid appraisal of personal significance of situations

Emotion energizes behavior and prepares for action

A,B,C's

-affect/physiology

-behavior

-cognition

• effects on cognition
• learning essential for survival
• can impair learning if non-adaptive
• Social
• affects behavior of others
• learn to regular our own behavior
• Health
• influences well-being, growth
• stress related to diseases 

Infancy

-developes over 1st yr w/ brain development

-caregiver input is important

early childhood

-learn strategies for self-regulation

-personality affects ability to self-regulate

middle childhood/adolescence

-rapid gains in regulation

-coping skills lead to emotional self-efficacy

• safe emotional experience (noone can actually hurt you in a scary movie)
• sensation seeking (adrenalin rush)
• cultural (haunted house w/ friends makes for bonding)
• social reinforcement (laughing after being scared)
• opponent-process theory (relaxing feeling after scary situation ends, attempt to maintain internal homeostasis)

• Trauma: Bad experience/trauma
• Modeling: Saw someone else have a bad experience
• Negative Information: heard someone had bad experience
• Biology: genetics

Could be all of the above.. additive effect over time from all sources

Associative: learned pathways or pairing w/ the feared stimuli (trauma, modeling, negative info)

Non associative: biological, genetic causes

-prepared aspect of learning certain phobias, not pre-wired but increased predisposition

-determined with retrospective reports of people with fears (when associative cause can't be found you assume non-associative cause

Panic attacks followed by at least 1month of distress, concern, or bx changes to prevent having another one

Panic attack is NOT a diagnosis, but you need a panic attack to have panic disorder

• Diversity (most samples are college students)
• context: environmental, stimulation, opportunites, how individual influences their environment
• timing of intervention: where the individual is going and where they've been
• developmental trajectory: course not a snapshot 

Developmental and psychological disturbances in children as the result of complex interactions over the course of development between the biology of brain maturation and the multidimensional nature of experience

(Nature/Nurture)

Sensorimotor (birth-2)

preoperational (2-7)

concrete (7-11)

formal operational (11+)

Affect

Behavior

Cognition

Frequency

Intensity

Duration

Age, developmental appropriateness

Somatic complaints

Withdrawn

Anxious/Depression

Social Problems

Thought Problems

Delinquent behavior

Aggressive behavior

(Achenbach's CBCL)

Overall lifetime prevalence rates for childhood problems between 14 & 22%

1 in 5 have problems

1 in 10 have diagnosable problems

20% that need services don't get it

• At least 2 well designed between group studies showing treatment is more effective than a placebo condition or equally effective as a treatment of established efficacy  or
• at least 9 single-subject studies comparing treatment to another treatment and showing experimental contrul

• 2 between group studies showing treatment is superior to a wait-list control
• 1 between group or 3 single-subject studies that meet criteria for well-established
• Studies that don't meet criteria of being shown by different research groups

Empirically supported: studies have shown some support but not necessarily a lot

Evidence based: compiles lots of studies showing effectiveness

(Rosenzweig, 1936)

showed common tx components accounted for all but .20 of variance

Problems with dodo:

-combined 150 ESTs into 5 groups

-included wide array of patients

-acutal comparison of specific tx showed large effect of individual tx components

• Insurance and gov't will regulat therapies and clinical decision-making
• proprietary use- copyrighting therapies by simply repackaging them
•  there isn't enough evidence, not enough RCT for everybody (not true, hierarchy of evidence)
• takes the 'art' out of clinical practice (not true, manuals guide best practice but flexibility needed)
• child therapy is diff bc a person is instrument of change (not true, effectiveness studies work)
• doctors have always gone by evidence anyways (not true, lots of historical evidence

over 900,000 confirmed by CPS as maltreated

61% neglect (most common maltreatment)

19% physical abuse (most common of abuse)

10% sexual abuse

5% emotional/psychyological

1,500 children die from maltreatment/year

1-3% school aged

5-6% adolescents

clinical setting:

8-15% children

50% adolescence

• Random external stressors: less odds of exposure (accidents, disasters, etc.)
• Family-dependent stressors: internal family problems (marital discord, parenting practices)
• Stress Generation: feedback loop, depressed ppl generate more stressful circumstances triggering more depression -- diathesis stress model 

Negative Cognitive Triad

Clark & Watson

Place less emphasis on general distress

Depression: more emphasis on anhedonia

Anxiety: more emphasis on physiological arousal

1 or more MDE AND at least one hypomanic episode

-Never experienced a manic or mixed episode (rapid alternation b/t depression and mania)

At least one manic episode

possibly depressive episode too (not necessary)

Narrow (DSM criteria), Broad is most referrals

Broad symptoms

If you take out episodes it looks a lot like several other disorders

-technically differentiated by flight of ideas, decreased need for sleep, promiscuous sexual bx, etc.

-assessment of BD needs to be a long-term process

-May lead to contraindicated treatment (lithium, AP, psychostimulants, AD)

Biederman

-helped fuel a 40 fold increase in bipolar disorder diagnosis

-corrupt studies, took a lot of funding from drug companies

interested in correlations between variables in large samples

• incidence: number of new cases in a defined period of time
• point prevalence: total number of cases at a specific moment
• period prevalence: total number of cases during a define period of time
• relative risk: probability of an event occuring in one group compared to the prob of it occuring in another group
• odds ratio: odd of an event occuring in 1 grp compared to the odds of it occuring in another grp

-Financial: direct and indirect costs

-mortality: deaths associated with a cause

-morbidity: incidence/prevalence rates

disability adjusted life years= (years of life lost+years lived with disability)/total years

Measure of the strength of a relationship between variables

Cohen's D

 <.19 negligible

.2-.49 small

.50-.79 medium

.80+ large

Pearson's r

<.09 negligible

.1-.3 small

.3-.5 medium

.5+ large

Determines if disorder is a categorical (taxonic) or a dimensional quality

Take a continuous variable and track the variability in the population, if there is more variability in the middle (a peak in the middle) that means it is categorical because both groups are present at that point

Genotype: molecular level, genetic characteristic

Phenotype: physical characteristic

Endophenotype: subtle, stable phenotypes that directly reflect the genotype

-can't see it at first glance (eg facial assymetry, eye-tracking

-imp bc they are closer to genotypes w/ less environmental influence

Epigenetics: Basic DNA sequenc stays the same but changes are present in how genes are expressed

A= additive genetics (heretability)=2+(rmz-rdz)

C = common environment=rmz-A

E = unique environment=1-rmz

(rmz=correlation b/ MZ twins, rdz=corr b/ DZ)

Pairwise=# of twins both ill/total twins

Probandwise= total siblings with ill sibling/total potential pairs 

Forward genetics: identify abnormal genes and link to endophenotype or phenotype (linkage studies)

Reverse genetics: include knockout gene- delete highly specific gene and then link to endophenotype or phenotype

-evolutionary perspective

-statistical perspective

-pragmatic

-skeptical antipsychiatry view

-value view

-harmful dysfunction

-Wakefield (judged off of harming individual and creating problems in evolutionary adaptive behaviors)

Kraepelin- founder of modern psychiatry, assumed biological in nature and classified based on symptoms

-Demantia Praecox (psychotic)

-Manic Depression

Instrumental vs. hostile

proactive vs. reactive

direct vs. indirect (relational)

overt vs. covert

undersocialized and socialized (early distinction)

Pervasive pattern of disregard and violation of other's rights starting by age 15

3 or more symptoms:

-failure to conform to norms regarding lawful bx, repeated acts that are grounds for arrest

-deceitfulness, lying

-impulsivity: not planning ahead

-irritability and aggressiveness: fights, assaults

-disregard for safety of others

-irresponsibility: can't hold a job

-no remorse: Indifferent or rationalizes action

18 yo, onset before age 15

DSM no includes psychological/affective symptoms instead of all bx symptoms like past editions

ODD: <1-20%, Median=3%

CD: <1-10%

DSM, 6-16% males and 2-9% females

Stability of symptoms across the lifespan but composition of bx change as individuals age

-patterns of bx change in predictable lawful ways

Shows consistent ways symptoms change across the lifespan (eg equifinality pathways to substance use)

Authority Conflict trajectory (defiance->serious conflict)

overt trajectory (early fight->overt agg->assault)

Covert Trajectory (shop lifting->serious property crime)

ADD onset = 7

CD onset = 9

proportion of individuals w/ ODD that will continue to have symptoms of CD

Different from sensitivity of construct: proprition of CD cases that previously had ODD

Lots of false positives

25% ODD --> CD

50% ODD --> ODD

25% ODD -->No diagnosis

1/10th of kids or less will go on to have ASPD from ODD

Worse prognosis but only if it is life-course persistent

-early onset with desist of symptoms isn't worse

More of a biological component, less influenced by parenting strategies

early onset aggression is #1 predictor of ASPD

-Continued px into adulthood w/ adolescent onset may be due to ongoing effects of px bx

Variable centered: does a variabley predict or differentiate b/ disorders (assumes a causal factor operates the same across subgroups)

Person centered: distinguishes b/ homogenous subgroups of ind that have the same or similar backgounds or risk variables

Hgihest for ADHD, moderate for overt bx, small for covert ASB

stronger for childhood onset, larger genetic influence as children age (gene-environment reciprocal interaction)

• low psychophysiological or cortical arousal
• autonomic reactivity
• early onset, agresssive, and undersoicalized groups have lower reactivity
• nonaggressive, socialized, late/onset have more elevated responses 
• Favoring the BAS (reward) system, cuases poor response to punishment

4:1 boys to girls, ratio gets closer in adolescents

Mutlifinality more imp for girls (change to emotional disorders)

92% some other psych disorder

62% anxiety

47% substance use

46% mood

35% ADHD

reactive: social isolation, peer rejection, social information processing deficits, social problem-solving deficits, hostile attribution bias, angry temperament, emotional dysregulation

proactive: lower levels ofa nxiety, anticipate agg will have positive effects

-higher heritability rates

-worse outcomes

-underly active emotional regulation (don't experience distress and remorse)

-parenting matters less w/ high CU traits

• chidlhood limited
• adolescent onset
• child onset from issues w/ emotional regulation (no CU traits)
• child onset w/ low levels of reactivity, empathy (CU traits present)  

Actuarial: based on formulas and objective data

Clinical: based on subjectivie, clinical opinion

6 aspects of construct validity

• content- all aspects are covered, relevance/representatativeness
• substantive-theoreitcal rational is good
• structural- fidelity of scoring
• generalizability-across settings, grps etc
• external- convergent and divergent (MTMM)
• consequential-implications and consequences

Content: representativeness of construct covered, taps all parts

Criterion: does it match up well with other things it is suppose to match up well with

Construct: ist he rational supporting the data collected good, explanation of concepts or theories

Negative predictive power: porportion of ppl indicated as not having disorder who truly dont

Positive predictive power: proporition of ppl indicated as having disorder who truly do

=true pos/(true pos + false pos)

Sensitivity: probability that a person w/ a disorder will be identified correctly

=true pos/(true pos + false neg)

Specificity: probability that a person w/out a disorder will be identified correctly

=true neg/(true neg + false pos)

• Lithium
• Antipsychotics
•  typical
• atypical
• stimulants
• amphetamine
• methylphenidate

Monitor glutamate levels

Moderate NE and 5-ht levels

block DA receptors

typical: chlorpromazine, promazine, haloperidol

atypical: clozapine, resperidol

Amphetamine (procentra, adderall, dexedrine, vyvanse) & methylphenidate (ritalin)

-effect vesicular level--increases concentrations of DA in cytosol of pre-synaptic neuron so increase release

-effects the DAT, induces reverse transport of DA from presynaptic neuron into synaptic cleft- block absorption

methyl also increases 5HT levels

• test-retest 1 wk = .84
• internal consistency = .94 (range .84-.88 subtests)
• content validity: experts, item discrimination coefficients (discriminative validity)
• criterion validity: Autism Behavior Checklist, related to the scales it should
• Discriminative validity:predictive power analysis of different diagnostic groups
• construct identification: not related to age, scales related to each other and autism index, differ significantly from ppl w/out autism

• Internal consistency: .63-.96 (dependent on scale) 
• Test Retest (12 months) = .61
• cross informant agreement = .61
• content validity- discriminative analysis differentating referred from non referred
• construct validity- correlations w/ BASC, Conners, and DSM checklists

test rest of 3 months = .59

cross-informant agreemtn = .61

• parenting bx
• assortive mating, SES, neighborhood (mediated by parenting)
• child abuse- really strong, esp for agg
• peer affiliation
• peer rejection
• early temperament (CU)
• poor attachment
• low IQ, poor neuropsych funct (mediated by ADHD)
• bx impulsivity (esp for early onset)
• social skills deficits
• lack of empathy
• poor interpretation of social cues
• egocentric outlook 

• females have increased comorbidity
• female agg=more peer rejection
• early maturation risk factor for girls only
• early reading px predicts later delinquency in females only
• relation agg more common in females
• girls have more multifinallity
• delinquen females more prone to assortivfe mating
• family disruption stronger risk factor for females