PSY240: - L9

Lecture §

• PDF:
  • Class9.pdf
• Prevalence of Childhood Disorders
  • About $20\%$ of youth have a psychological disorder
  • ADHD, CD, Anxiety Disorders
• What are some issues with assessing and Treating Children
  1. Parents’ and teachers’ reports are often considered more important in assessment than the child’s input.
  2. Examine the role that the environment plays in children’s symptoms
  3. Some childhood problems persist or become worse into adulthood
     • Homotypic continuity: predictive of future same diagnostic
     • Heterotypic continuity: predictive of future different diagnosis
       • Anxiety to depression; ADHD to ODD
• Externalizing: Oppositional Defiant Disorder & Conduct Disorder
  • Diagnostic: What are the 3 diagnostic categories of ODD
    • (A) . A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness. At least four symptoms from any of the following categories
      • Angry/Irritable Mood
        • Often loses temper
        • Is often touchy or essily annoyed
        • Is often angry and resentful
      • Ar-mentative/Defiant Behavior
        • Often argues with authority figures or for children and adolescents, with adults
        • Often acively defies or refuses to comply with requests from authority figures or with rules
        • Often deliberately annoys others
        • Often blames others for his or her mistakes or misbehavior
      • Vi-ictiveness
        • Has been spiteful or vindictive at least twice within the past 6 months
    • (B) The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context, or it impacts negatively on social, educational, occupational, or other important areas of functioning.
    • (C) The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. The criteria are not met for disruptive dysregulation disorder
  • Prognosis: From ODD to CD
    • ODD can be diagnosed at 4; while CD are diagnosed after 10
    • ODD -> CD -> Antisocial Personality Disorder
      • $25\%$ of boys
      • Can be comorbid
    • ODD may be linked to emotional disorders in adulthood
      • (e.g., depressive disorders)
    • CD might lead to behavioural problems in adulthood
      • (e.g., criminal offenses, difficulty in roles involving responsibility)
  • Diagnostic: What are the 4 major group of conduct disorder
    • Presence of at least three of the following 15 criteria in the past 12 months
    1. Aggression directed toward people and animals
       • Often bullies, threatens, or intimidates others.
       • Often initiates physical fights.
       • Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
       • Has been physically cruel to people.
       • Has been physically cruel to animals.
       • Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
       • Has forced someone into sexual activity.
    2. Destruction of property
       • Has deliberately engaged in fire setting with the intention of causing serious damage.
       • Has deliberately destroyed others’ property (other than by fire setting).
    3. Deceitfulness or theft
       • Has broken into someone else’s house, building, or car.
       • Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
       • Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).
    4. Serious violations of rules (truant)
       • Often stays out at night despite parental prohibitions beginning before age 13 years.
       • Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.
       • Is often truant from school, beginning before age 13 years
  • Symptoms: 5 Traits specifier in DSM for CD
    1. With limited prosocial emotions
    2. Lack of remorse or guilt
    3. Callous – lack of empathy
    4. Unconcerned about performance
    5. Shallow or deficient affect
  • Prevalence: What is the sex difference and prevalence of ODD and CD
    • CD: Boys are $3-4\times$ more likely than girls to meet the diagnostic
    • ODD: Slightly more boys than girls
    • Prevalence: ODD $9-12\%$ (3-6% adolescence); CD $1-10\%$
  • Etiology: Causes for CD and ODD
    • What percentage does genetic play in CD
      • $71\%$ for CD in twin studies
      • There exist a strong link between CD and the family (both gene and environment)
    • Environmental factors
      • Marital conflict, divorce, child abuse
      • Prenatal risk factors
        • Maternal stress
        • Smoking during pregnancy
      • Psychosocial risk factors
        • Poor parenting (ex. harsh/inconsistent discipline, child abuse, low monitoring)
        • Harsh discipline more commonly used with difficult children
    • What are the 4 neurobiological factors
      1. Damage to the Prefrontal Cortexand to the Amygdala
      2. Aggression has also been linked to lower heart rate and skin conductance (especially in people high in psychopathy)
      3. Early difficult temperament, poor social cognition, lower IQ and lower executive functioning (comorbidity with ADHD)
      4. Low norepinephrine linked to CD; link to serotonin in adults
    • Gene-environmental Interactions
      • $80\%$ of individuals were severely maltreated in childhood and had low monoamine oxidase A (MAOA) activity had CD in adulthood
      • The differential susceptibility theory and the biological sensitivity to context theory suggest that a supportive environment can attenuate biological vulnerability.
  • Treatment: What are the 4 common treatment for CD & ODD
    1. Problem-solving training can lead to significant improvements in children’s behaviour
    2. Pharmacological treatment includes mood stabilizers, typical and atypical neuroleptics and stimulants
    3. Parent training interventions: coercive process
    4. School- and community-based treatments

Questions §