Transcript Developmental Psychopathology

Developmental Psychopathology
Disorders of Childhood
Classifying Childhood Disorders
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Diagnosticians must determine what’s
normal for a given age.
(temper tantrums at 10, not normal)
Disorders of Under-controlled
behavior
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1. Attention-Deficit/Hyperactivity Disorder
(ADHD)
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2. Conduct Disorder
ADHD: Symptoms (overall)
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Child in constant motion
Fidgeting
Disorganization
Impulsivity
Difficulty getting along with others
Aggressiveness
Have difficulty reading social cues
Difficulty sustaining attention/poor
concentration
ADHD: Three Subcategories
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1. Children with problems primarily of
poor attention (ADD).
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2. Children whose difficulties result
primarily from hyperactive-impulse
behavior.
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3. Children who have both sets of
problems.
Prevalence of ADHD:
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Difficult to determine, because of varied
definitions of this disorder over time.
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Estimates—2 - 7% in the US
3 –5% worldwide
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More likely in boys than girls, boys more
likely to be comorbid with conduct disorder.
ADHD: When does it become a
problem???
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Becomes noticeable in preschool years, when
children have difficulty controlling their activity &
interacting with their peers.
Big myth of ADHD—hyperactivity doesn’t
disappear in adolescence as was once thought.
65 - 80% of kids with ADHD still meet criteria in
adolescence & adulthood.
Prevalence of symptoms in ADHD &
normal adolescents (Barkley, 1990)
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Symptom
Fidgets
Easily distracted
Difficulty remaining
Seated
Blurts out answers
Difficulty (attention)
Interrupts others
Talks excessively
ADHD%
73.2
82.1
Normal%
10.6
15.2
60.2
65.0
79.7
65.9
43.9
3.0
10.6
16.7
10.6
6.1
Theories of ADHD
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Biological---Genetic factors—
When parents have ADHD, 50% of their child do
too.
Adoption studies & twin studies show genetic link
---Neurological factors—
Frontal lobes under responsive to stimulation &
cerebral blood flow is reduced.
Kids with ADHD have brains that developed
differently, not resulting from brain damage.
Theories of ADHD (cond)
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ADHD not linked to:
sugar/preservatives
Lead
ADHD is linked to:
Maternal smoking (prenatal)!!!
--increases dopamine release in baby’s
brain—leading to hyperactivity
ADHD: Treatment
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1. Medication- stimulants prescribed since
1960s (Ritalin).
Stimulant effects-paradoxical –improve
ability to concentrate/reduce disruptions.
In double-blind designed studies, 75% of
kids with ADHD showed dramatic
improvements with stimulants.
Treatment (cond)
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2. Psychological techniques—
behavioral techniques based on operant
conditioning work well.
Applied Behavior Analysis
Improves academic achievement, ability to
concentrate, social interactions, etc.
Conduct Disorder:
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Is a repetitive & persistent pattern of seriously antisocial
behavior, usually criminal (illegal) in nature & marked
by extreme callousness.
Diagnosis is made in individuals under 18
Behaviors may include (but not limited to):
Cruelty toward animals and/or people
Vandalism
Lying
Theft
Physical aggressiveness
Behavior is often—vicious, callous, remorseless
DSM-IV TR Criteria for Conduct Disorder
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Repetitive & persistent behavior pattern that violates the basic rights of
others or conventional social norms as manifested by the presence of 3
or more of the following in the previous 12 mos. & at least one of them
in the previous 6 mos.:
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A. Aggression to people & animals (e.g., bullying, initiating physical
fights, being physically cruel to people or animals, forcing someone
into sexual activity).
B. Destruction of property (e.g.,fire-setting, vandalism).
C. Deceitfulness or theft (e.g., breaking into another’s house or car,
conning, shoplifting).
D. Serious violation of rules (e.g., staying out at night before age 13 in
defiance of parental rules, truancy before age 13).
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**Significant impairment in social, academic, or occupational
functioning.
**Person must be under 18 years of age.
Conduct Disorder & comorbidity
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ADHD
Substance use disorders (alcohol, marijuana)
Note—CD & drug use occur concomitantly &
exacerbate each other.
Anxiety
Depression (15-45%)
Girls with CD are significantly more likely than boys
to develop these other disorders, suggesting greater
psychopathology in the girls than in the boys.
What is prevalence of conduct
disorder?
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A review of several epidemiological studies indicates
that prevalence rates range from 4 to 16% for boys &
1.2 to 9% in girls (Loeber et al., 2000).
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Violent crimes (rape, assault) are largely crimes of
male adolescents.
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Incidence & prevalence of illegal activity peaks by
age 17 & then drops precipitously in young
adulthood.
What is prognosis of Conduct
Disorder?
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Prognosis is mixed. More than half of
children with conduct disorder do not
become antisocial personalities in adulthood
(Loeber, 1991; Zoccolillo et al., 1992).
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However, research shows that most conduct
disordered boys do continue to demonstrate
some conduct problems into adulthood
(Lahey et al., 1995).
Do kids with conduct disorder become
antisocial adults?
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Yes, some children diagnosed with conduct
disorder meet criteria for antisocial
personality disorder into adulthood.
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Males with conduct disorder who had
fathers with antisocial behavior & poor
verbal intelligence, more likely to develop
APD.
Moffitt’s theory: Two courses of
conduct disorder:
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Moffitt argues that two different courses of
conduct problems should be distinguished.
1. Life-course persistent –Some individuals show a
pattern of antisocial behavior beginning with problems
by age 3 & continuing into adulthood.
2. Adolescent-limited – Other conduct disorder
individuals started out with normal childhoods, but
produced high levels of antisocial behavior during
adolescence that does not continue into adulthood.
Etiological factors for Conduct
Disorder
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1. Biological Factors
Is conduct disorder heritable??
*There is some evidence that conduct disorder is
genetic.
Twin studies show a genetic link for conduct disorder,
although the extent of link varies with the samples
examined.
Adoption studies in Sweden, Denmark, & U.S. show
that criminal & aggressive behavior is accounted for
by both genetic & environmental factors.
2. Neuropsychological deficits in
children with conduct disorder
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Poor verbal skills
Difficulty with executive function
Memory impairments
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Children who develop conduct disorder at an earlier
age have been shown to have an IQ score of 1
standard deviation below age-matched peers without
conduct disorder.
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This IQ deficit is not attributable to lower SES, race,
or school failure (Lynam, Moffitt, & StouthamerLoeber, 1993).
2. Psychological factors
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A. Deficient moral awareness-- Children with
conduct disorder often lack guilt & remorse for
their antisocial & aggressive behaviors.
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B. Conduct behaviors are learned-1. Modeling– children learn aggressive
behaviors by observing parental aggression and/or
abuse in the home. Evidence supports both of
these factors.
2. Imitation- kids will imitate antisocial peers
3. Faulty thinking/perceptions
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Cognitive processes of aggressive children have a
specific bias—children perceive ambiguous acts as
evidence of hostile intent.
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Children with these faulty perceptions may
retaliate to “perceived attacks” that were actually
not intended to be hostile.
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This may lead to aggressive behavior in response
to these attacks…. The vicious cycle then
continues.
4. Peer Influences
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Peers influence aggressive & antisocial behaviors
in others in 2 ways:
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1. Rejection by peers has been shown to be
causally related to increased aggressive
behavior (e.g., Dylan Klebold & Eric Harris—
Columbine High School massacre).
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2. Association with Deviant Peers—increases
frequency of deviant behavior in others (“Running
with the wrong crowd”).
Treatment
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A. Family Interventions—treatment involves
parents & families of antisocial child.
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Using a behavioral program of parental
management training (PMT), Patterson &
coworkers have taught parents to modify their
responses to children so that positive social
behavior is rewarded.
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Parents use positive reinforcement (rewards) when
the child produces positive behaviors & timeout/loss of privileges for aggressive or antisocial
acts.
B. Multisystemic Treatment
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Henggeler’s MST has demonstrated reductions in
arrests 4 years following treatment (Borduin et al.,
1995).
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MST—is an intensive & comprehensive therapy
that provides services for the adolescent, his/her
community, the family, school, & peer group.
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Therapy targets not just child but all individuals in
the child’s life (hence, multisystemic).
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Treatment is provided in home, school, church,
community centers, etc.
Does MST work??
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Yes!!!! Compared with a control group who
received standard individual therapy, the MST
group demonstrated fewer antisocial behaviors &
arrests over the following 4 years.
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While 70% of adolescents receiving standard
therapy were arrested in the 4 years after
treatment, 22% of the subjects receiving MST
were arrested (Davison, Neale, & Kring, 2004).
Pervasive Developmental Disorders:
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Rett’s disorder, Childhood disintegrative
disorder, Asperger’s disorder, Autism
What is Autism?
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Autistic disorder, first identified by Leo
Kanner in 1943, is a disorder of that impairs
an individuals social and cognitive
functioning.
DSM diagnosis-Autistic Disorder
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A total of 6 or more items from A, B, and C below, with at least two from A and one each from B and
C:
A. Impairment in social interactions as manifested by at least 2 of the following:
Marked impairment in use of nonverbal behaviors such as eye contact, facial expression, body
language.
Deficit in development of peer relationships appropriate to developmental level.
Lack of spontaneous sharing of things or activities with others.
Lack of social or emotional reciprocity.
B. Impairment in communication as manifest by at least one of the following:
Delay in or total lack of spoken language without attempts to compensate by nonverbal gestures.
In those with speech, marked impairment in ability to sustain/initiate a conversation with another.
Repetitive or idiosyncratic language
Lack of developmentally appropriate play
C. Repetitive or stereotyped behaviors or interests, manifested by at leaste one of the following:
Abnormal preoccupation with objects/activities
Rigid adherence to certain rituals
Stereotyped mannerisms
Abnormal preoccupation with parts of objects
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Delays or abnormal functioning in at least one of the following areas, beginning before age 3: social
interactions, language for communication with others, or imaginative play.
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Disturbance not better described as Retts disorder or childhood disintegrative disorder.
Autism: Symptoms
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Poor eye-contact
Poor social interaction-don’t initiate play
with others
Language delay (regression)- 50% never
learn to speak at all.
May be preoccupied with objects (spinning,
twirling)
Rigidity; lack of adaptiveness, rituals
important.
Tactile aversion
Etiology: Autism
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1. Biological factors
There is a genetic link.
--60-91% concordance rate in monozygotic
twins.
is only 0-20% in dizygotic twins.
Brains of autistic males significantly larger
than in normal males.
2. Psychological theories:
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Lack of maternal love (long been dispelled).
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3. Other theories: (these have been ruled
out)
--MMR & other vaccines (ruled out)
Abdominal parasites—yeast (ruled out)
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Treatment: Autism
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Best—Applied Behavior Analysis!!!!
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Lovaas method—multiple discrete trials
targeting child’s ability to attend, imitate
actions, play with objects, learn social
skills, etc.
What is Korsakoffs Syndrome?:
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A disease that develops in individuals who chronically
consume alcohol.
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-caused by a thiamine (vitamin B 1) deficiency that
occurs almost exclusively in severe alcoholics.
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-memory loss—severe retrograde & anterograde
amnesia.
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neurological damage is diffuse, striking damage in
dorsal medial nucleus of thalamus, frontal cortex.
What is Alzheimer’s Disease?:
 Is a progressive degenerative disease that
ultimately results in death, marked by severe
retrograde & anterograde amnesia.
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Early onset: late 40’s early 50’s prior to
60’s, is more severe that late onset!
-Late onset: after 65, we have 50% chance
of developing this by age 85.
Alzheimer’s Disease: Symptoms
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starts with minor forgetfulness (where’s
checkbook, etc.)
Steadily progresses to serious memory loss
Depression
Restlessness
Hallucinations & delusions (seeing dead
relatives)
Anterograde & retrograde amnesia
Alzheimer’s Disease: Genetic
basis???
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-does seem to run in families, especially in
families with early onset.
-Best evidence--nearly all Down’s Syndrome
patients will eventually develop the disease if
they survive to middle age.
-It may depend on at least 2 or 3 different
genes
Alzheimer’s Disease: Neurological
damage
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1. There is widespread atrophy of the cortex with
plaques & tangles in the hippocampus.
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2. Entorhinal cortex is also destroyed, acetylcholine
neurons are diseased.
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3. The plaques contain deposits of a protein known as
Beta-amyloid. An injection of this protein into a rat’s
brain can damage neurons & produce symptoms
resembling those of Alzheimer’s disease.
. Open-Head Injuries:
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Puncture or penetration of the skull through projectiles
(gunshots/missile wounds) or other moving objects.
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Most people with open-head injuries do not lose
consciousness & produce distinctive symptoms that
may undergo rapid & spontaneous recovery.
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Deficits are specialized & often resemble those of
surgical excisions.
Closed-Head Injuries
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Caused by a blow to the head (car accident,
blunt instrument swung at head).
Damage at site of blow is called a coup.
With severe blow, the brain may shift & hit
the opposite side of the skull producing an
additional bruise (contusion) known as a
countercoup.
Closed-Head Injuries (Contd.)
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Finally, the brain may suffer additional damage,
from the shearing of nerve fibers resulting in
microscopic lesions.
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Frontal & temporal areas most likely to be damaged in
closed-head injuries.
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These injuries are common accompanied by loss of
consciousness (from damage to brainstem fibers), edema
(swelling), and hemorrhaging.
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Length of coma often is positively correlated with
severity of damage.