Term
| ADHD: Projectile Trajectory |
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Definition
problems maintaining employment
relationship problems
substance abuse
multiple arrests and convictions |
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Term
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Definition
3-5% school age children
rates drop in adolescent boys
more common in boys
one of the most common mental health disorders |
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Term
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Definition
Oppositional defiant disorder and Conduct Disorder : 30-50%
Learning disorders: 25%
o Reading most common
Anxiety disorders: 25%
o Inattentive only at greatest risk
Depression: 20% |
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Term
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Definition
Cause is unknown
Likely CNS deficit- brain (frontal lobe)
Children do NOT outgrow ADHD
• 1/3 manage, receive treatment, are fine
• 1/3 continue same level of problems
• 1/3 develop additional disorders |
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Term
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Definition
Parental transmission- more likely from dad
o 30% of fathers who have ADHD will transmit
Concordance rates- twins
o Identical- 81%
o Fraternal- 29% |
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Term
| ADHD: Neurotransmitter Influences |
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Definition
Dopamine- influences impulsivity and three seeking behavior
Quays Neuropsychological model- all externalizing disorders
o Combined type kids
o Behavioral activation system (BAS)
Stimulates in response to reward or non punishment
• Gas pedal
• Overactive
• Heightened sensitivity to rewards, seek external rewards
o Behavioral Inhibition System (BIS)
• Inhibits in presence of punishment or novel situations
• Breaks
• Under active
• Fail to respond to normal punishment
o Evidence
• Frontal love (executive functioning- planning and problem solving) and prefrontal cortex appear under stimulated
• Basal ganglia (executive functions) abnormalities- react without fear |
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Term
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Definition
• No evidence bad parenting is a blame for ADHD
• Bad parenting can exacerbate problem
o So ADHD doesn’t comorbid with ODD/CD |
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Term
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Definition
| • Not actually due to sugar, food additives |
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Term
| ADHD: Treatment Psychosocial |
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Definition
• Parent- management training
• teaches parents how to implement behavior modifications
o lasts 8-12 sessions/ weeks (for white, midclass- takes longer in community outreach because families have other problems like poverty)
• goals:
o establish and consistently enforce rules
o ignore mildly inappropriate behavior
o praise positive behavior
o use token economy
• Classroom intervention- daily report card (drc)
• Choose specific target behaviors (Johnny will get __% of work done)
• Establish a home based reward system |
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Term
| ADHD: Treatment Pharmacological |
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Definition
• Stimulants (over 90% of ADHD get this)- Focalin
• Stimulate frontal lobe (improve focus, problem solving, etc.)
• Non stimulants
• Generally safe and effective (for 2/3 kids)
o Some don’t respond to one type of drug but respond to other
o For other 1/3 nothing works |
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Term
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Definition
• Cognitive problem solving skills treatment
• Shouldn’t be used by itself but is effective when used with other treatment
• Teach kid appropriate attributions
• Emotional insight and management
• Social problem solving |
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Term
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Definition
• Pattern of negativistic, hostile, and defiant behavior lasting at least 6 months
• Look at developmentally inappropriateness of behavior |
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Term
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Definition
• Opposition- active resistance to limitations, resrtictions, or directions, “push the limits”
• Defiance- deliberate contradticting/provoking others, seem to argue just to argue
• Onset around age 4 or 5 |
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Term
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Definition
• Repetitive/persistent pattern of behavior in which basic rights of others or major age apporpriate societal norms rules are violated
• Plus additional symptoms in 4 major categories: (see chart in book)
• Aggression to people and animals
• Destruction of property
• Deceitfulness/ theft
• Serious violations of rules |
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Term
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Definition
• Childhood onset type (aka early onset)
o ~ 4 to 8 years
o At least one symptom prior to age 10
o More severe, less frequent
o Low remission, high innovation
• Low remission- behaviors escalate over time
• High innovation- behaviors are varied and occur in multiple contexts
o These kids have the worst prognosis
• Adolscent onset type
o Late childhood, early adolescense
o 0 symptoms prior to age 10
o Less severe, more frequent
o High remission (behaviors disappear over time) and low innovation (behaviors don’t vary)
o Better prognosis problems liekly go away over time, less likely to have genetic basis like in child onset |
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Term
| Delinquency vs. Conduct Disorder |
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Definition
• Delinquency legal term for crimal behaviors
o Officially delinquent when arrested and convicted
o All CD are delinquent not all delinquent are CD\
• Conduct Disorder clinical term for pattern of distruptive and antisocial behaviors, regardless of legality, more serious/long term than delinquency |
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Term
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Definition
o Horizontal dimension: overt vs. covert
• Over- observable (fighting)
• Covert- not observable (lying/stealing)
o Vertical: destructive vs. Nondestructive
• Destructive- harm (vandalism)
• Nondestructive- no harm (truancy)
o Kids with overt and destructive have worst developmental trajectory, higher risk of developmental trajectory, higher risk of developing criminal behaviors and psych. Disorders |
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Term
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Definition
• Instrumental aggression: intended to achieve a goal, means to an end, happens lots in little kids (hit to get a toy) because they want something but lack verbal skills and control
• Should decrease at around preschool (but hostile aggression increases)
• Hostile aggression: intended to inflict harm
• Risk factor for later psychological disorders
• Direct Aggression: confronting/ attacking victims directly, more common in girls than in boys
• Indirect aggression: sneaky harmful behavior, “relational aggression”, more common in girls than in boy, know far less about it than direct aggression
• Why happens?
• What are good interventions?
• See pyramid diagram in book
• Oppositional symptoms (ex. Tantrums)
o Happens most and earliest
• When kids move into jr. high they use weapons/lie (less frequent but more severe)
• Adolescence: still more severe but less frequent (ex. Mug, rape, steal)
• See chart in book on adolescent limited path (adolescent onset, usually then decreases over lifespan, less extreme and less likely to drop out of school, situational behaviors less bad) vs. life course persistent path (child onset with a worse trajectory) |
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Term
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Definition
• Psychopathy- pattern of callous, manipulative, deceitful, and remorseless behavior
• not a diagnosis but used in clinics and legal situations
• more common in child onset
• impulsive, don’t care about others, aggressive
• can be identified in kids ages 3-5, kids tend to not have a conscious
• Antisocial personality disorder (ASD)
• Pervasive pattern of disregard for violation of rights of others
• Diagnosed starting at 18, not all kids with CD go on to have this disorder (and CD is childhood specific, must be under 18) |
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Term
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Definition
2-6% (less common than ODD)
• Age of onset: early to mid adolescence (later than ODD)
• More common in boys
o DSM doesn’t include covert symptoms that many CD girls show-they could be flying under the radar
• See book chart: age specific prevalence vs. age in years (boys show behaviors more than girls but boys and girls peak and drop off in behaviors in the same time frame/patterns) |
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Term
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Definition
2-10% prevalence
• Age of onset: preschool to early school age
• Develops earlier in boys than girls (twice as common in boys than girls) |
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Term
| Conduct Problems comorbidity |
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Definition
o Comorbidity:
• ADHD (50% of ODD/CD kids have ADHD)
• Drug and alcohol abuse
• Lately greater abuse of prescription drugs
• Mood and anxiety disorders |
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Term
| Conduct Problems: Etiology Genetic Factors |
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Definition
o Adoption and twin studies
• 50% attribute to heredity
o Difficult child temperament
• Restless, impulsive, risk-taking
o Partially affect BAS (overactive- need rewards) and BIS (under active- don’t respond to punishment)
o Neuropsychological deficits
• Lower verbal IQ, executive function problems, impulsivity
• However, most of these studies have been done on jailed people, maybe these people just dumber/get caught? |
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Term
| Conduct Problems: Etiology -Social Cognitive Factors |
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Definition
• Social information processing deficit
o Hostile attribution bias- misinterpret and think people are doing things out of hostility
• Poor social skills
o Bad at picking up on social cues |
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Term
| Conduct Problems Etiology -Family Factors |
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Definition
• Parental psychopathology and criminality
o Runs in families, due to genes and environmental
• Parenting
o More common with permissive parent style
o Lack of parental supervision
o Coercive parental interactions
• Each person escalates other person’s behavior
• Family stress and instability
o Multiple bfs/gfs of either parent, moving around
• Family disruption/chaos
o Marital conflict and family violence |
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Term
| Conduct Problems Treatment |
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Definition
• Parent management training (PMT):
• Teach effective parenting skills
• Change coercive interactions
• Cognitive problem-solving skill training (PSST)
• Teach appropriate appraisals and attributions
• Emotional insight and management
• Problem-solve in social situations
• * PMT and PSST used in combination with older children
• Multisystemic Treatment (MST)
• Family systems approach
• Targets dysfunctional family relationships
• May include other social influences
• May include components of PMT and PSST
• highly effective- requires a ton of labor
• long waitlists- state funded if psychological issue and law issue |
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Term
| Conduct Problems Prevention |
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Definition
• Apply parent, child, and/or family therapy components to universal or at risk populations
• Highly effective if intervene early |
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Term
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Definition
• Universal reactions to unsafe situations and threats
• Adaptive evolution at work
• Follow developmental trajectory
• Change in a consistent way |
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Term
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Definition
• Characterized by strong negative emotion and bodily symptoms of tension in which future danger or misfortune is anticipated
• Physical
• Cognitive
• Behavioral → avoidance |
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Term
| Separation Anxiety Disorder |
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Definition
• Developmentally inappropriate fear that something bad will happen upon separation
• Reassurance or reasoning doesn’t lessen fear
• Symptoms vary with age but manifest across domains
• Make themselves ill |
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Term
| Anxiety: General Adaptation |
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Definition
• Young children- 7 and under
o Clingy at home, shadow parents, and become upset if parent is out of sight for any amount of time
o Unhappy and inconsolable until reunited with caregivier
o Refuse to sleep alone
• Marital conflict, family distruption
• Older Children 9-12
o Call home repeatedly
o Visit during middle of day
o Problems concentrating in school
o Refuse extracurricular activities
o Seek parents approval and lack independence
o Refuse to sleep alone |
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Term
| Generalized Anxiety Disorder Symptoms |
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Definition
• Excessive and uncontrollable anxiety and worry for more days than not for 6+ months
• Worries about different events or activities, often developmentally inappropriate |
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Term
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Definition
• Low self-esteem
• Perfectionist
o Expect too much from themselves → set themselves up for failure
• Excessive need for reassurance |
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Term
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Definition
• Obsessions- recurrent and intrusive anxiety provoking thoughts and impulses
o “urges” “images”- cognition less in young kids
o always extreme, always intrusive
• compulsions: repetitive, ritualistic behaviors to reduce anxiety associated with obsessions
o child feels forced
o if interfered with, may have panic attacks, temper tantrums
o vary considerably
• checking, looking, washing, only wear loose clothes, only eats smooth foods |
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Term
| OCD Developmental Trajectory |
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Definition
• Child at first seems rigid and odd
o Flicks lights a few times, washes hands a few extra times
• Orderliness turns more extreme and broad
o Entire family forced to comply to compulsions
• Behaviors become entrenched and disruption causes severe distress to child and family
o Not for attention
• Daily functioning and entire family affected |
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Term
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Definition
• 50-60% of youth with OCD face major problems of adaptation at home
o mental and emotional exhaustion
o school refusal and oppositional behavior |
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Term
| Posttraumatic Stress Disorder Criteria |
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Definition
• Trauma involves actual or threatened death or serious injury
• Response of intense fear, helplessness, or horror
o Agitation/disorganization in children |
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Term
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Definition
• Intrusive symptoms: recurrent recollections of events including images, thoughts, or perceptions
o Keep having flashbacks occurring during disruptive times
o Dreams, sensations, hallucinations, flashbacks
• Adolescence, older kids
• Disassociated
o Repetitive re-enhancing play in children
• Young children
o Can be cued by reminders of trauma
• Avoidance of symptoms- active avoidance of memories or emotions surrounding trauma
o Avoid thoughts, places, people, events
o Partial or total memory loss
• Older kids
o Little interest in activities
o Detachment and restricted range of affect
• Little kids
o Guilt, pessimism, and hopelessness
• Hyper arousal symptoms- body on alert
o Problems sleeping
o Irritability
o Lack of attention and concentration
o Hyperviligence
o Exaggerated startled response |
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Term
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Definition
10%
• Most common anxiety disorder in children
• Earliest age of onset
• No gender differences |
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Term
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Definition
• 3-6% of children/adolescents
• age of onset- early in school age
• more common in girls |
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Term
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Definition
• 1-2% of children/adolescent
• age of onset- preadolescent/early adolescent |
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Term
| Anxiety General Comorbidities |
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Definition
• Other anxiety disorders
• Depressive disorders |
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Term
| Anxiety Etiology-Genetic influences |
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Definition
• Vulnerability partly inherited (not disorder specific- doesn’t have to be same disorder)
o Twin studies – higher with identical
o Family studies- 2 parents with anxiety- higher risk |
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Term
| Anxiety Etiology Neurotransmitters |
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Definition
o Seratonin- problem with reuptake too much at synapse
o GABA
o Norepinephrine- inhibitory |
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Term
| Anxiety Etiology Temperament and regulation |
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Definition
o Inhibited temperament- irritated and agitated
• Later shy, fearful, and cautious
o Behavioral Inhibition System (BIS) overactive
• Monitors threats and allows control and planning |
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Term
| Anxiety Etiology- Psychosocial factors |
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Definition
• Behavior models
• Classical conditioning (phobias)
• Modeling- mom and dad anxious- reinforce behavior
• Cognitive models
• Learned helplessness
• Dysfunctional Family relationships
• Insecure attachment
• Authoritarian parenting
o High control, unrealistic expectations, little autonomy
• Exposure to marital conflict |
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Term
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Definition
o Cognitive Behavioral Therapy
• Psychoeducation- kid and parents understand how developed and how to reverse
• Relaxation training- debriefing, imaginable and imagery
• Cognitive restructuring
• Not as affective with young kids
• Fear hierarchy and exposure
• Modeling and role playing
• Most effective with parent training
o Pharmacological Treatment
• SSRIs: selective serotonin reuptake inhibitors
• Few studies on children
• Antidepressants
o Effective for reducing symptoms in OCD
o Other than OCD, mixed results |
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Term
| Major Depressive Disorder (short term but intense) |
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Definition
• Table 8.1- 5 or more symptoms present in same 2 week period- change from previous functioning
• At least 1 has to be depressed mood or loss of interest
• In children irritable mood
• Average episode lasts 8 mos |
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Term
| Major Depressive Disorder Developmental Trajectory |
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Definition
• Young children- irritability
o Physical complaints
• Older children- sadness and hopelessness
o Often times not a “why”
o Anhedonia- lack of interest
o Vegetative symptoms- weight gain, sleeping fatigue
o Suicidal ideation- thinking about suicide |
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Term
| Major Depressive Disorder Other symptoms |
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Definition
• Suicidality
o Thoughts- in a community sample about 40% will report they’ve had suicidal thoughts
• Clinical population- 75%
o Attempts- 13% of kids with MDD will attempt
• 26% of adolescence will attempt
• perception of not having a support system
• having means to do it
• family history
• alcohol or other drugs
• sudden stressful event
• if already attempted
• Psychotic Symptoms
o 30-50% have hallucinations → visual and auditory
o decrease with age, but poor prognosis |
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Term
| Major Depressive Disorder Developmental Trajectory |
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Definition
• Young children- irritability
o Physical complaints
• Older children- sadness and hopelessness
o Often times not a “why”
o Anhedonia- lack of interest
o Vegetative symptoms- weight gain, sleeping fatigue
o Suicidal ideation- thinking about suicide |
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Term
| Major Depressive Disorder Epidemiology |
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Definition
• 1-2% in school age children
• 3-8% in adolescents
• age of onset- 14-15 years old
• prevalence increases with age (esp. with girls) |
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Term
| Dysthymic disorder (long term- lower grade |
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Definition
• Table 8.2 depressed mood most of the time for 2 years
• In children can be irritable and only 1 year
• Very continuous- can’t be without symptoms for more than 2 mos at a time |
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Term
| Dysthymic Disorder General Adaptation |
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Definition
• Problems in intellectual and academic functioning
o Depressed moods is a distraction- can look like ADHD
• Depressive ruminative style
o A lot of focus on bad things
• Ineffective coping
o Avoidance, drugs and alcohol
• Low self-esteem
• Social withdrawal
• *all maintain depression |
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Term
| Dysthymia Disorder Epidemiology |
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Definition
• 1% of children; 5% of adolescents
• age of onset: 11-12yrs
• initial period lasts ~ 4 yrs
• tends to develop into other disorders
o 70% dysthymia kids will later have MDD
o 40% anxiety disorders
o 30% conduct disorders |
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Term
| Etiology MDD and dysthymia Genetic factors |
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Definition
o High genetic transmission- 50% accounted for by genes
• Twin family studies
• Identical twins 2-4x more likely to have if I has
• 25-50% will have if parent has |
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Term
| Etiology MDD and dysthymia Neurotransmitters |
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Definition
o Norepinephrine- deficiency
o Serotonin- may cause norepinephrine to drop |
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Term
| Etiology MDD and dysthymia Psychosocial factors |
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Definition
o Attachment theory- insecure attachment axious
o Behavioral theory- learning theory principles
• Child quits receiving positive reinforcement for appropriate behavior- gets attention for being depressed |
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Term
| Etiology MDD and dysthymia Psychosocial factors Cognitive theory |
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Definition
• “depressogenic” cognitions
• aaron beck
o negative cognitive schemas- focus on negative
o cognitive triad: self, world, future
• all negative
• Martin Seligman
o Depressive attributional style
• Negative outcomes: internal stable, global
• Positive outcomes: external, unstable, specific |
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Term
| MDD and Dysthymia Treatment |
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Definition
• Cognitive behavior therapy
o Address negative cognitions
o Increased pleasurable activities
• Interpersonal therapy
o Focus on dysfunctional relationships
• Antidepressants
o SSRIs |
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Term
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Definition
| • One or more: manic, hypomanic, or mixed episode usually with depressive episode |
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Term
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Definition
• One week period of elevated/irritable mood
• Inflated self-esteem/grandiosity
• More talkative than usual
• Racing thoughts of ideas
• Distractibility
• Hyperactivity/decreased need to sleep
• Excessive risky activities
• Extreme irritability |
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Term
| Hypomanic and mixed episodes: |
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Definition
• Hypomanic episode- symptoms persist for 4 days; not as severe as manic episodes
o Not as impaired, no psychotic features
• Mixed episode- manic and major depressive episode occurs for at least one week |
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Term
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Definition
1 manic or mixed episodes and1+ more major depressive episodes
o No periods of normal functioning |
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Term
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Definition
| 1+ hypomanic episodes and 1+ major depressive episodes |
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Term
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Definition
| 2 years of hypomanic and depressive symptoms |
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Term
| Manic episodes in children |
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Definition
• Irritability
• Explosive temper tantrums (guilt)
• Low frustration tolerance
• Impulsivity
• Difficulty sleeping at night
• Difficulty concentrating on tasks
• Mood or sad
• Problems with academic performance
• Nightmares frenzied activity |
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Term
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Definition
• Auditory hallucination
• Delusions or persecution
• Passive feelings of mind control
• Though disorganization
• Loose associations |
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Term
| Bipolar Developmental trajectory |
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Definition
• Age of onset important factor- usually within first 20 yrs.
• Adolescence period of high vulnerability
• Early onset worse prognosis
o Chronic and continuous course
o Fewer episodes of remission
o Severe symptoms
• Suicide, substance abuse, delinquent
o Mixed presentation of depression and manic |
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Term
| Bipolar Differential Diagnosis and Comorbidity |
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Definition
• Bipolar and ADHD
o Share a number of diagnostic and associated features differences in nature and course
• Chronicity- ADHD chronic
• Most kids with bipolar have episodic course
• Age of onset- younger for ADHD
• Bipolar- late adolescence
• Psychotic symptoms- not in ADHD
• Additional symptoms- ADHD not grandiose
• No promiscuous behavior
• Comorbidity
• Some kids have both
o No stimulants |
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Term
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Definition
• Vulnerability stress model
o Strong biological/genetic basis
• Twin studies
• Family studies
o Environmental factors also play role in triggering
• Family factors
• Life stress |
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