1
Q
What is abnormal behaviour/behaviour problems? (8)
A
- Abnormal behaviour
- Behavioural disturbance (ex. Sudden panic attacks)
- Emotional disorders (ex. Anxiety disorders)
- Psychological deficit (ex. Lower IQ)
- Mental illness (ex. Bipolar disorder)
- Psychopathy
- Maladaptive behaviour (ex. Bad stress)
Developmental disorders (ex. Atypical cognitive functioning)
2
Q
What 2 systems examine a range of abnormal behaviours?
A
- Extremes: fails to acquire expression language by age 6, 14 year old believing aliens control his thoughts, 10 year old boy who can’t leave the house without turning the light switches on/off 3 times, etc…
- Subtle: child who runs around and cannot settle, child who is exceptionally withdrawn and quick to tears, child with little use of words and seems echolalic, etc…
3
Q
5 factors we consider to determine that behaviours are abnormal
A
- behaviours that are not just atypical, but harmful
- behaviours that are developmentally inappropriate
- cultural norms, gender norms, situational norms, developmental norms
- role of the adult
- changing views of abnormality
4
Q
The APA defines a disorder as clinically significant if there is a pattern of:
A
- distress
- impairment
- increased risk of death, pain, disability, or loss of freedom
5
Q
Developmental norms describe (3):
A
- rates of growth
- sequence of growth
- forms of physical skills, language, cognition, emotion, and social behaviour
6
Q
Developmentally inappropriate signs (8)
A
- developmental delay
- developmental regression
- extremely high or low frequency of behaviour
- extremely high or low intensity of behaviour
- behavioural difficulties that persist over time
- abrupt changes in behaviour
- several problem behaviours
- behaviour that is irregular or qualitatively different from the norm
7
Q
How do cultural norms affect behaviour
A
They have a sway in how adults in different cultures treat or respond to different behaviours
Ex. Teachers in Mainland China rate hyperactivity, inattention, impulsivity, etc. much higher than teachers in Hongkong and the UK because these behaviours are more frowned upon in China and more normal in the UK
8
Q
How do gender norms affect behaviour?
A
Gender stereotypes play a key role in how judgements about behaviour are considered normal or abnormal
(Males = more aggressive, dominant, active, adventurous; Females = passive, dependent, quiet, sensitive, and emotional)
Ex. Males are more often diagnosed with ADHD and females are missed
Ex. Females present very differently than males on the autism spectrum, and therefore get diagnosed much later in life
9
Q
How do situational norms affect behaviour?
A
Situational information may change the way we interpret a certain behaviour
Ex. A child who is running around, flitting from one activity to another, yelling, cannot settle: ADHD or a child playing at recess?
Ex. A child who is sullen, socially withdrawn, and quick to tears: depression or a child who just lost their pet?
Ex. A child with little use of words, generates nonsense words, seems echolalic: autism? A 15 month old vs a 14 year old?
10
Q
How does the role of adults affect behaviour?
A
How they interpret the child’s behaviour has an important role in the outcome of diagnoses
Ex. Kipland (school shooting story): parents and teachers dismissed his concerning behaviours
11
Q
Diagnoses made at different times across development (4 groups):
A
Early (1-3):
- language disorders, autism spectrum disorder, some intellectual disorders
- when first words don’t come, it’s quite noticeable early on
Around 4-6:
- ADHD, learning disorders
- start interacting with other kids at school and can see their behaviour in comparison to other kids their age
- noticeable difficulties with reading, writing, math emerge - if still struggling to catch up by grade 2/3, learning disorders are diagnosed
Around 9-11:
- conduct disorders
- usually misdiagnosed earlier as ADHD
Later (13-15 and on):
- schizophrenia, substance abuse, bulimia/anorexia
- societal triggers, major life changes, greater access to substances
12
Q
How does gender impact the identifying of disorders? (6)
A
- timing of onset (ex. Males diagnosed with autism significantly younger (4-6) than females (14-18))
- severity of the disorder/behaviour
- expression of the disorder/behaviour (ex. Females on the autism spectrum express differently than males: more social, more aware)
- cause of the disorder (ex. Some disorders linked to x or Y chromosomes)
- sequence of development
- developmental pathways
13
Q
What is prevalence
A
A measure of the total number of cases of disease in a population
14
Q
Prevalence depends on: (2)
A
- the definition of the disorder: makes use of standardized scales or formal diagnostic criteria
- population sampling: prevalence may be based on clinical or community samples
15
Q
World Health Organization estimates on mental illness:
A
- they estimate that mental illness will be the greatest burden by 2030
- Covid has had a great impact on increasing mental illness in youth, especially eating disorders, anxiety, and depression
- emotional and behavioural problems on the rise in preschool children
16
Q
According to the APA, how many children have a fairly significant mental health need?
A
1 in 5 children
17
Q
Goals of the field of developmental psychology: (4)
A
- identify, describe, and classify psychopathology
- determine etiology
- develop and refine treatment plans
- plan proper prevention
18
Q
Central tenants of the field of developmental psychology: (6)
A
- psychological problems stem from multiple causes
- normal and abnormal behaviour must be studied together
- systematic approach to study is needed
- treatment and prevention need to continue to grow and improve
- children have a right to high quality treatment
- advocacy is needed
19
Q
What makes up the therapeutic alliance?
A
Multidisciplinary teams: psychologists, psychiatry, social worker, special education, paediatricians, occupational therapists, teachers, educational assistants, school admin, etc.
- everyone working together with the families to develop an intervention plan
20
Q
How many children with mental health disorders do not receive adequate treatment?
A
Estimated 2/3 or 3/4 of children
21
Q
What are some barriers to treatment? (4)
A
- poverty
- minority/immigrant status
- rural residence (lack of resources)
- negative attitudes towards mental health treatment
22
Q
The developmental psychopathy perspective
A
Integrates our understanding and study of normal developmental process with those of child and adolescent psychopathology
23
Q
The developmental psychopathology approach
A
- blends developmental psychology with clinical and adolescent psychology with paediatric psychiatry
- studies the original and developmental course of disordered behaviour including individual adaptations and success
24
Q
Systems framework (developmental psychopathology approach): (4)
A
- biological
- behavioural
- cognitive
- family systems
25
Understanding psychopathology:
Depends on the identification of multiple variables that affect development and the environment that surrounds it (context)
26
Causes of psychopathology (direct vs. indirect)
Direct effects: variable X leads straight to outcome
- ex. Down syndrome directly caused by a specific chromosome
Indirect effects: variable X influences other variables which in turn lead to the outcome
- ex. Major concussion leads to anxiety or depression because you can’t play hockey anymore, your social life is affected, you fall behind in school
27
Mediators vs moderators
Mediators: explains the relationship between variables that produce an outcome
- flows through mechanism processes; shows connection; has an influence on the relationship
Moderators: a factor that influences the relationship between variables
- changing strength and direction, and even existence of the relationship
28
Psychopathology causal factors (3)
Necessary - must be present
Sufficient - can be responsible alone
Contributing - are not necessary or sufficient but may add to the effects
29
Pathways of development (5)
Stable adaptation
- few environmental adversities, few behavioural problems, good self worth
Stable maladaptation
- chronic environmental adversities (ex. Aggression, antisocial behaviours maintained)
Reversal of maladaptation
- important life change creates new opportunity (ex. Military career affects opportunity when given a scholarship)
Decline of adaptation
- environmental or biological shifts bring adversity (ex. Family divorce contributes to maladaptation)
Temporal maladaptation
- can reflect transient empirical risk taking (ex. Use of drugs)
30
Mediator and moderator models
A variable can be a mediator or a moderator depending on how you put it into the model
Mediator model: the mediator must cause a higher statistical correlation between dependent and independent variables
Moderator model: analysis using a moderator tests the effect of a moderator variable on the relationship between an independent variable and dependent variable
Ex. A study finds that sleep quality can affect academic achievement through the level of individual attention
- mediator = attention
- sleep quality is not the only thing that impacts academic achievement; attention is another variable that gets flowed through and also impacts academic achievement
Ex. A study finds that youth who score high on callous unemotional traits moderates the relationship between hours playing video games and aggressive behaviour
- moderator = callous unemotional traits
- when this trait is not there, there is no relationship between video games and aggressive behaviours
31
Pathways of development- equifinality vs multifinality
Equifinality: refers to diverse paths and factors which result in the same outcome
- pathway 1, pathway 2, pathway 3 —> antisocial behaviour
Multifinality: identifies that the same experiences may result in multiple different outcomes
- maltreatment during childhood —> depression, anxiety, aggression
32
Examples of developmental risk factors (9)
- genetic abnormalities
- prenatal or birth complications
- below average intelligence or learning disability
- psychological/social factors
- aversive parenting style
- under resourced household or community
- disorganized household or neighborhood
- racial ethic or gender injustice
- non-normative stressful events
33
Risk factors - definition
Precede an impairment and increase the chance of a disorder
34
Protective factors - definition
The opposite of risk factors; are personal or situational variables that reduce the chance of psychopathology
35
Effects of adverse childhood experiences and risks of: (7)
- premature mortality
- autobiographical memory disturbances
- prescribed psychotropic medications in adults
- alcohol use during adolescence
- sexual abuse
- depressive disorders in adulthood
- adult mental health issues
Etc…
36
Why do some succeed and others do not? Resilience attributed to : (3)
- persistence
- courage
- strength of character
37
Resilience - definition
A consequence of individual characteristics and environmental factors that would be beneficial to most children at risk
A relatively positive outcome in the face of significant adverse or traumatic experiences
38
Ordinary magic
Individuals who have experienced adversity and have some of these individual/family/social characteristics that have benefited them.
Ex. Oprah: given up after birth, young pregnancy , sexual abuse as a child —> had persistence and had teachers who saw the persistence, got a scholarship, went on to have a very successful career in entertainment
Ex. Shania Twain: grew up poor, parents divorced, had to sing in local bars when she was 8 to make money for her family to eat —> persistence, went to school, became a famous singer despite early adversities
39
Individual characteristics of resilience (3)
- good intellectual functioning
- good temperament
- self efficacy, self confidence, high self esteem, talents
40
Family characteristics of resilience (4)
- close relationship with caregivers
- authoritative parenting, warm, structure
- socioeconomic advantages
- supportive family network
41
Social and community characteristics of resilience (3)
- mentors (adults) outside of the family
- engagement in community-based programs
- effective schools
42
How does unremarkable (average) development lead to less than optimal outcomes?
Normal development and less than optimal outcomes can proceed together
- attachment
- temperament
- emotion regulation
- social cognitive process
43
Attachment - definition
- Socio-economic bond between an infant and their parent/significant caregiver
- typically develops in infancy (emerging between 7-9 months)
- viewed as biologically hard wired in both infant and caregiver
44
4 attachment styles
Secure
- 80% of infants have this attachment style
- uses a parent as a secure base, upset at separation
Insecure/avoidant
- easily separates from parent, avoid/ignores the parent, does not prefer parent to strangers
Insecure/resistant (or ambivalent)
- 10% of families have this kind of attachment
- very afraid by strangers, extremely upset separation and unable to be soothed by parent
Disorganized/disoriented
- may express fear toward parent, freeze behaviour and expressions for short periods, reluctant
45
Temperament - definition
- the child’s disposition; a product of complex interactions between biology and environment over time
- composite of reactivity to stimuli, regulation of bodily functions, mood, and adaptability to change
- thought to be stable across the lifetime
- those with more difficult temperaments tend to have more atypical psychological behaviours
- goodness of fit between parent and child (ex. Difficult temperament parent and difficult temperament child, vs. Easy parent and difficult child)
46
3 types of temperament
- easy
- slow to warm
- difficult
47
Emotion and it’s regulation
Expressiveness, understanding, regulation/dysregulation
Ex. Kids with autism may have difficulty expressing the emotions they are feeling
Regulating emotions gets better with age
- kids or teens that have a difficult time regulation emotions will have more atypical behaviours and more psychopathology
Individual differences in threshold and intensity to emotional experiences
Gives clues to level of distress and sensitivity to environment
48
Social cognitive processing - definition
How social situations within the social environment are understood and interpreted
49
3 parts of the forebrain
- hypothalamus
- amygdala
- cerebral cortex
50
Hypothalamus
Basic urges
51
Amygdala
Emotion regulation
52
Cerebral cortex (parts)
Occipital cortex
Parietal cortex
Temporal cortex
Frontal cortex
53
Brain development (steps)
- the embryonic development generates an over abundance of nerve cells
- axons migrate
- genes determine axons trajectory and connections to target cells
- more axons than target cells can accommodate
- activation of selective pruning
- synaptic density increases up to the age of 2 years
- after 2 years, levels decrease as a result of synaptic pruning
- changes in synaptic density occur at different rates in different areas of the brain
- it is the action of EXPERIENCE that results in the consolidation of circuits and the pruning of unnecessary synapses
54
Prenatal influences on the developing CNS (5)
- poor maternal diet and stress
- drugs and alcohol
- medications
- radiation and environmental contaminants
- disease
55
Perinatal influences on the developing CNS (2)
- medications during childbirth
- complications during labour (ex. Anoxia)
56
Postnatal influences on the developing CNS (5)
- accidents
- illness
- malnutrition
- accidental poisoning
- brain injuries
57
Genotype vs phenotype
Genotype: actual gene makeup
Phenotype: expression of gene makeup
58
Single gene inheritance
- dominant gene
- recessive gene
- proband case
59
Multiple gene inheritance
- heritability
- twin studies- shared and non-shared environmental influences
60
Gene environmental interactions (G x E)
A differential sensitivity to experience based on your genotype
61
3 types of gene environment correlations
Passive: parents pass both genes and a gene-related environment to their offspring
- ex. Pass on an outdoorsy loving gene and provides an environment where they are outside often
Reactive: reflect child’s genetic makeup and others’ reactions to the gene-related characteristics
- ex. Seeing certain behaviours that they have been genetically given and encouraging these behaviours
Active: based on child’s genetic endowment and the child’s selection of gene-related experiences
- ex. Choosing environments that best suit your own genetic makeup
62
Operant conditioning
Recognizes that positive consequences of a behaviour will strengthen it and a negative consequence will weaken it
63
Positive vs negative reinforcement
Punishment
Positive reinforcement: stimulus presented. Increases the behaviour
Negative reinforcement: stimulus withdrawn. Increases the behaviour
Punishment: decreases the behaviour
64
Operant conditioning: generalization, discrimination, shaping
Generalization: extends to new behaviour
Discrimination: predictive of response
Shaping: rewards close approximations to establish behaviour
65
Observational learning
Albert Bandura identified that problem behaviours can be acquired through observation of a model
To learn a new behaviour pattern by imitating the performance of someone else
66
Cognitive process
- individuals perceive their experiences
- construct concepts or schemas that represent their experience
- sort information in memory and employ their understanding to think about and act in the world
67
Cognitive behaviour model (Kendall)
- holds that behaviours are learned and maintained by their interactions of internal cognitions and emotions with external environmental events
- underlying hypothesis is that maladaptive cognitions are related to maladaptive behaviour
- cause of phobic and anxious children
68
Cognitive structures
Schema for representing information that are constructed from experience
69
Cognitive content
Information stored in the cognitive structure
70
Cognitive process
How people perceive and interpret experience
71
Cognitive products
Structures/content and processes interacting with events
72
Cognitive distortions
Inaccurate thought processes that are dysfunctional
- treated by CBT
73
The CBT model
- Identify the problem
- thoughts
- feelings
- behaviours
- body talk
- choices
74
Community temper taming project
Identifying the problem (cognitive structures and content)
- learning to recognize anger (circle faces that look angry)
- evaluating my own anger (colour a scale of how angry they are right now)
- the places I get angry (school, home)
- when I get angry (getting ready, sharing, TV time, gym class)
The thoughts (cognitive processes)
- what is going through my brain (draw inside their brain when they are angry)
- perspective taking (write what the cartoon characters are thinking)
The feelings (cognitive processes)
- identifying feelings that precipitate anger (circle faces of emotions they feel before getting angry)
- normalizing feelings (“sometimes I feel sad. Do you ever feel sad?”)
The body talk (cognitive products)
- recognizing physiological expression (body talk bingo with things they experience when angry)
- identifying my own physiological expression (colour in a body to show how they feel when angry)
Recognizing inaccurate thoughts (cognitive distortions)
- “I can’t do anything right”
Making choices
- putting it all together (reflective worksheets)
- learning options (get help from others, count to 10, talk about the problem (choose it); throw something, give up, yell (lose it))
The results
- decrease in children’s rating of anger
- decrease in parents’ rating of anger
- decrease in aggression
- decrease in hostility
75
Sociocultural context - definition
Ecological model includes the family, community, and culture.
The model is interactive across all levels
76
Parenting styles - definition
Attitudes, goals, and patterns of parenting that affect the outcomes for children
Two major dimensions:
- degree of control
- degree of acceptance
77
4 types of parenting styles
Authoritative (high control, high acceptance)
- set and enforce standards, considerate of children’s needs, encourage independence and individuality
- associated with the most favourable outcomes
- ex. Burt Hummel
Authoritarian (high control, low acceptance)
- strictly set rules which cannot be challenged, use fairly severe punishment
- ex. Battle hymn of the tiger mother
Indulgent/permissive (low control, high acceptance)
- make few demands for mature behaviour, allow children to regulate themselves
- ex. Regina George’s mother
Neglectful (low control, low acceptance)
- uninvolved, give little time/attention/emotional commitment to children
- ex. Dad from shameless
78
Canadian department of justice rates on child maltreatment
- an estimated 7000 child maltreatment cases investigated across Canada in a 3 month period
- a rate of almost 22 investigations for every 1000 children in Canada
- nearly half (45%) were substantiated
79
Peer influence on development
- social friendships and peer relationships are important parts of development
- beneficial to the development of: sociability, empathy, cooperation, morality, handling conflict and competition, control of aggression, socialization of sexuality and gender roles
80
School influences on development
- schools provide an environment for peer relationships to develop
- student-teacher relationships can be a protective factor
81
Social economic status and poverty influences on development
- low SES is associated with higher risk for psychological problems
- poverty is linked to increased risk for negative outcomes like developmental delay, learning disabilities, school failure, behavioural, and psychological problems
82
Questions researchers ask in developmental psychopathology (8)
- how common are disorders?
- how do disorders change over time?
- what causes abnormality and what are the underlying mechanisms?
- what puts youth at risk and what protects them?
- what demographic factors are associated with specific disorders?
- how can disorders be prevented?
- what is the nature of disorders?
83
Types of researchers in developmental psychopathology (4)
- clinicians
- epidemiologists
- developmentalists
- neuroscientists
84
Scientific method
Hypothesis
Deductive reasoning
Prediction
Observation
Test of the prediction
Induction interpretation
85
Is research in developmental psychology definitive?
No.
Can interpret the data and infer findings, but there are so many different factors that can change the way data is interpreted
86
Validity
Refers to the correctness, soundness, or appropriateness of the scientific finding
87
Internal validity
Refers to the extent to which the explanation is judged to be correct or sound
88
External validity
Refers to the extent to which the findings can be applied to other situations, or whether results are generalizable
89
Content validity
Refers to whether the content of a measure corresponds to the content of the attribute of interest
Ex. A researcher wants to study mathematical learning
90
Construct validity
Refers to whether a measure corresponds to the construct (concept) underlying the attribute of interest
Ex. Researcher wishes to develop a new IQ test
91
Face validity
Refers to whether a measure, on its surface, seems appropriate to the attribute of interest
How the measure appears. Does it seem well-designed?
92
Concurrent validity
Refers to whether the scores on a measure correlate with scores on another acceptable measure of the attribute of interest
93
Predictive validity
Refers to whether the scores on a measure predict later scores on another acceptable measure of the attribute of interest or another outcome of interest
Ex. Predictive validity of high school SAT scores correlating with GPA in first year university
94
Reliability
Other researchers must be able to perform the exact same experiment and under the same conditions, produce similar and consistent observations and measurements
95
Interrater reliability
Two different experimenters who are measuring the same variable at the same time and their scores are the same
96
Basic methods of research (4)
Naturalistic observation: involves observing the individual in the “real world”
- ex. Observe a child in the classroom
Descriptive: observational and involves a single case study
- ex. Observe behaviour in a controlled environment (in the lab)
Non-experimental: explores relationships; no manipulative variables
- ex. Looking at how parent-child relationships relate to one another, without manipulating anything
Experimental: manipulative variables
- randomized: subjects are allocated into groups randomly
- quasi-experimental: subjects are not randomly assigned
97
The case study
- a descriptive, non-experimental method
- focuses on the individual, detailed report of the person and treatment used, provides a hypothesis, tries to bridge gaps between research and practice
- poor reliability, validity, and generalizability
98
Correlations studies
- non-experimental studies that describe the relationship between two variables without exposing the participants to manipulation
- represented by correlation coefficient r
- range is +1 to -1
Closer to 1 (positive or negative), the more correlation
99
Single-case experimental designs
- experimental manipulation with a single participant
- ex. Single case study on a child with cerebral palsy, giving them a robotic walking aid to see the impact on their ability to walk (could not use multiple participants because of the cost)
100
Reversal designs
- subject is evaluated at a baseline (A) before intervention, exposed to intervention, then evaluated during another baseline period (A2)
- only seen in interventions, without lasting changes
-ex. ADHD medication - very short acting lifespan, no lasting effects
101
Multiple baseline designs
When reversal designs are not appropriate; more than one behaviour is of interest; same behaviour in different settings; multiple participants
102
Cross-sectional research
- often a number of different ages at the same time point are sampled
- caution: differences at one age level may be due to bias in that particular group
103
Retrospective longitudinal research
- interested in past events
- may look at a disorder and inquire about characteristics at an earlier age
- may examine data that has already been collected
- caution: data is only as good as past records, questions may be limited by the range of data collection
- ex. ASD sibling studies
104
Retrospective case control study
- one group that is presently diagnosed with a disorder is compared to another group (control) without the disorder
- usually used to seek hypotheses about predictors or causes of the disturbance
105
Prospective longitudinal research
- same child at different time points
- permits the examination of newly emerging disorders, risk factors, gender effects, etc.
- super expensive (about $1m per year)
106
Qualitative research
- utilizes principles of naturalistic observations - recorded as narratives
- usually involves focus groups, interviews, in-depth case study, life histories
- collects non-numerical information
-categories and themes arise from the data, instead of being set a priori
107
Ethics in research
- science should adhere to principles that are sensitive to the rights of an individual, both ethically and legally
- it has been recognized that research, no matter how well intentioned, can cause unanticipated harm to participants
Ethical guidelines are essential
108
Ethical guidelines (USA and worldwide)
- Belmont Report (USA)
- the American and Canadian Psychological Association (guide the ethical principles of psychologists and their code of conduct)
- the declaration of Helsinki
- International Registration of Clinical Trials (worldwide)
109
Ethical guidelines in Canada
We have the 2nd edition of the Tri-Council Policy Statement: ethical conduct for research involving humans (TCPS-2)
110
3 federal research agencies that make up the Tri-council
The Canadian Institute of Health Research (CIHR)
The Natural Sciences and Engineering Research Council (NSERC)
The Social Sciences and Humanities Research Council (SSHRC)
111
Internal ethics board
To adhere to the policies, universities must establish an Institutional Review Board (IRB or HiREB)
They consider issues such as:
- the scientific soundness of the proposed research
- voluntary consent of the participants
- potential harm and benefits to the participants
112
Tri-council policy statement (foundation & 3 core principles)
The foundation of the TCPS-2 is the value of respect of the human dignity
There are 3 core principles to the TCPS-2:
- respect for the persons
- concern for welfare (protect from any unnecessary risks)
- justice
113
Free and informed consent, and 3 aspects of consent procedure
- most ethical guidelines require that participants give voluntary informed consent
- part of the respect for individuals
- most often involves obtaining written consent
Included in the consent procedure:
- participants need to know the purpose of the research
- the procedures, the risks, and the benefits
- to know their rights and options to refuse or withdraw at anytime
114
Voluntary informed consent
Assumes:
- children cannot fully understand the issues
- children cannot make proper informed consent
Therefore, until children have reached the legal age of consent (16), the legal guardian consents on their behalf
In older children, it is practice to ask participants to assent (agree to participate)
In clinical groups, it is important to identify that participation is completely separate from any treatment received
115
Consent: child issues
There may be interest in the outcome of the research from parents, schools, or programs/agencies who are involved in the child’s life
Considerations:
- limits on the information that is shared
- detailed consent about what will be shared
- information that might impact the child’s health or wellbeing
116
Classification- definition
The delimitation of major diagnostic categories and dimensions of behavioural disorders
Importantly:
- clear, well defined categories or dimensions
- be able to communicate one disorder from another
- be able to demonstrate that the category or dimension actually exists—> features occur regularly, in a number of situations, and can be measured by a number of methods
Dimensions: can occur in varying degrees (ex. Anxiety)
117
If we were to design our own classification system:
Reliability (have consistency)
- inter-rater reliability
Valid (correctness)
- what do we know about the syndrome/disorder?
- how would the person respond to treatment?
- does the disorder really exist?
Clinical utility
- how useful is the classification system in the clinic?
118
Diagnostic and statistical manual of mental disorders (DSM-5)
Clinically derived that was based on the consensus of clinicians regarding:
- concepts of a disorder
- diagnostic criteria
Uses a categorical approach:
- difference between typical and pathological = categorical —> based on type of behavioural expression and not the degree
DSM-5 is organized in groups of related disorders (no more axes)
- ex. Neurodevelopmental disorders, anxiety disorders, trauma related disorders, etc.
119
Approach of the DSM-4
DSM-4 used the multiracial approach. It assessed 5 dimensions:
Axis 1: clinical syndrome
Axis 2: developmental disorder
Axis 3: physical conditions
Axis 4: severity of psychosocial stressors
Axis 5: highest level of functioning
120
Examples of neurodevelopmental disorders (7)
- intellectual disability
- communication disorders
- autism spectrum disorder
- ADHD
- specific learning disorders
- motor disorders
- tic disorders
121
DSM-5 diagnostic characteristics of ADHD
- persistent pattern of inattention and/or hyperactivity
- present before age 12
- present in at least 2 settings
- interferes with developmentally appropriate functioning
- does not occur exclusively with other disorders
- must demonstrate at least 6 symptoms
Key symptoms: inattentive/hyperactivity, impulsivity, behavioural manifestations
122
Subtypes of ADHD
- combined subtype
- predominantly inattentive
- predominantly hyperactive
123
Associated features with ADHD
- low frustration tolerance
- temper outbursts
- bossiness
- stubbornness
- excessive and frequent insistent that requests be met
- mood lability demoralization
- dysphoria
- rejection by peers
- poor self esteem
124
Criticisms of the DSM-5 (3)
Reliability (consistency)
- recent versions of the DSM-5 are better with symptoms based on criteria that varies with the disorder. Ex. Trained interviews have higher reliability
Validity (correctness)
- concerns over it’s utility. For example, it is a good description of clinically significant differences in psychological functioning, concerns over the need to link treatments and etiology, and concerns over cultural and gender issues
Transdiagnostic?
- similar treatments that are effective for two or more disorders
125
Comorbid disorders
The co-occurrence of two or more distinct disorders in the same patient
- may represent a wide range of symptoms in the individual
- may exist as a consequence of a shared set of risk factors
- one disorder may have increased the likelihood of the second
- may have a developmental progression
Ex. 60% of children diagnosed with ADHD are also diagnosed with autism
126
Empirical approach to classification
- derived through experimental and statistical means
- usually involves asking parents or teachers to identify the absence or presence of a behaviour in the child (and to quantify the frequency and intensity)
127
Empirical approach - child behavioural checklist (CBL)
Definition, broadband + narrowband syndromes
CBL uses a statistical measure like factor analysis
Includes teacher report form, parent report form, youth self report (11-18 year olds)
Broadband syndromes:
- internalizing behaviours: over controlled/anxiety withdrawn
- externalizing behaviours: under controlled/conduct problems
Narrowband syndromes;
- anxious/ depressed
- withdrawn/ depressed
- somatic complaints
- social problems
- thought problems
- attention problems
- rule breaking behaviour
- aggressive behaviour
128
Types of assessments (8)
- clinical interviews
- problem checklists
- observational assessments
- projective tests
- intelligence assessments
- developmental scales
- achievement measures
- neuropsychological testing
129
Clinical interviews - 3 types
Unstructured
- the clinician determines what is asked and the order of the questions (ie. developmental history, presenting problems)
Semi-structured
- fixed order for questions, how the questions are posted and the way the responses are recorded (ie. Vineland Adaptive Behaviour Scale-II)
Structured
- the interviewer asks the same questions, fixed language, according to a fixed recording schedule
- there is a KID-SCID version
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Problem checklists
- intake interview
- multiple respondents
- normative sample (norm vs clinical)
Ex. CBCL, BASC Conners
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Observational assessments
- behavioural observations
- can inform treatment planning
- observation system may require some training
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Projective tests
Rorschach tests (ink blots)
- less common today
- based on psychoanalytic ideas about “projections”
House, tree, person tests
- may be used as a way of exploring past experiences and present desires
- ambiguous stimuli serve as a way of exploring these elements
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Intelligence and educational assessments
- evaluation intellectual functioning
- WISC-C for 6 to 16 years
- WPPSI-III for 2 years & 6 months to 7 years & 3 months
-WAIS for adults (17+)
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5 components of the WISC
Verbal comprehension
- vocabulary
- similarities
- information
- comprehension
Visual spatial
- block design
- visual puzzle
Fluid reasoning
- matrix reasoning
- figure weights
- picture concepts
- arithmetic
Working memory
- digit span
- picture span
- letter-number sequencing
Processing speed
- coding
- symbol search
- cancellation
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Achievement measures
Wide range achievement test (WRAT-4)
Wechsler individual achievement test (WIAT-3)
- used for 4-50 year olds
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4 composites of the WIAT-3
Oral language
- listening comprehension
- oral expression
Reading
- early reading skills
- word reading
- pseudoword
- reading comprehension
- oral reading fluency
Written expression
- alphabet writing fluency
- sentence completion
- essay
- spelling
Mathematics
- math problem solving
- numerical operations
- math fluency - addition, subtraction, multiplication
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Neuropsychological tests (3)
Computed Axonal Tomography (CAT)
- 3D structural image based on x-rays
Positron emission tomography (PET)
- metabolic distribution of radio-labeled tracer
Functional MRI (fMRI)
- areas of increased neural activity in response to cognitive/emotions processing
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Preventions (3)
Universal prevention —> selective prevention —> indicated prevention
-increasing difficulties
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Intervention settings
- home
- school
- primary care clinic
- outpatient unit
- inpatient unit
- etc…
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Play therapy
- tool that clinicians use to build rapport with the kids (make them feel safe, familiar)
- can also be therapeutic: can shape and guide behaviours in kids (through how you respond to the child)
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Parent training and family therapy
- even CBT has a parent component to it
- want kids to generalize behaviours to all environments (ex. Home)
- parent has to understand the program so they can continue the child’s skill building at home
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Triple P (positive parenting program)
- encourages parents to teach in a more authoritative way (more mindful, more positive reinforcement, be more present, set boundaries)
- 10 week program
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Anxiety - definition
A future-oriented emotion characterized by perceptions of uncontrollability and unpredictability over potential aversive events and a rapid shift in attention to the focus of potentially dangerous events or one’s own affective response to these events
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Fear vs worry
Fear: reaction to immediate or present threat; a reaction to specific stimulus
Worry: the cognitive components of anxiety; involving thoughts about possible negative outcomes that are difficult to control
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Tripartite model of fear and anxiety
- behavioural response
- cognitive response
- physiological response
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Anxiety is part of normal development…
Children have many more fears than generally appreciated.
Older children: fears are hidden or masked.
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Different anxiety disorders (7)
- separation anxiety disorder
- selective mutism
- specific phobia
- social anxiety disorder (social phobia)
- panic disorder
- agoraphobia
- generalized anxiety disorder
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Separation anxiety symptoms (must show 3 of 8)
-show excessive distress when separated from attachment figure or home
- persistent worry about losing or harm happening to attachment figure
- persistent worry about events that will lead to separation from attachment figure
- persistent reluctance or refusal to go to school
- persistent refusal to go to sleep without being near attachment figure
- persistent fear of being alone without attachment figure
- repeated nightmares involving theme of separation
- repeated complaints of physical symptoms when anticipating or separated from attachment figure
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Separation anxiety disorder - diagnostic criteria
- show 3 out of 8 symptoms
- have an attachment figure (mom, dad, caregiver) and/or home
- symptoms must be present for 4 weeks and occur before 18 years
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Prevalence of separation anxiety disorder
- 3-12% (higher in children than adolescents)
- often meet criteria for GAD
Retrospective data:
- show greater risk for panic disorder and agoraphobia
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Specific phobias - definition
Persistent fear of a specific object or situation that is unusual or excessive, beyond voluntary control, lead to avoidance, and interfere with normal functioning
Subcategories: animal, natural environment, injections, situational, other…
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Specific phobias across development
Behaviourally: avoidance, panic, disgust
Cognitively: child may inflate the outcome
Physiologically: nausea, rapid heart rate, difficulty breathing
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Social anxiety disorder - definition
- fear of acting in an embarrassing or humiliating way in social or performance situations
- interferes significantly with the child’s normal routine, academic functioning, and social relationships
- fear of social situations: speaking/reading in public, initiating conversations, speaking to authority figures, interacting in informal social situations
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Social anxiety disorder across development
Behaviourally: avoidance of situations
Cognitively: concerns about embarrassment, negative evaluation
Physiologically: somatic complaints
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Social anxiety disorder - prevalence
Age of onset: middle to late childhood
1-2% of children in the general community
3-4% in adolescents
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Generalized anxiety disorder - definitions
- excessive anxiety and worry
- worry excessively and exhibit extensive fearful behaviour
- worries not focused on specific objects or situations
- co-occurrence with other anxiety disorders
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Generalized anxiety disorder - prevalence
2-14% in the community population
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Panic attacks- definition
A discrete period of intense worry or fear that has a sudden onset and reaches a peak quickly in 10 minutes or less
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Panic attacks - 3 categories
Unexpected panic attacks (uncued)
- occur spontaneously with no apparent triggers
Situationally bound (cued)
- panic attacks occur on almost all occasions where the child is exposed to the fears, object, or situation
Situationally disposed
- panic attacks occur on exposure to the cue, but not all the time. May also occur following exposure rather than immediately
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Panic disorders - definitions
- involves a number of unexpected panic attacks
- individual is concerned that it will occur again without warning and significantly effect behaviour
Subtypes: panic disorder with or without agoraphobia
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Agoraphobia- definition
- an attempt to avoid circumstances that are uncontrollable to potentially embarrassing
- fear of having panic attacks in situations where escape is unavailable
- ie. terrified to leave the house
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Panic disorder - prevalence
- rarely diagnosed prior to mid or late adolescence and difficult to diagnose
- 3-4% in adolescents
- as high as 16% in youth between 12-17 years in community samples (one of the disorders that are least likely to be reported)
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PTSD definition and symptoms (3)
Requires exposure to a serious traumatic event which the child shows an intense fearful reaction
Symptoms:
- re-experiencing
- avoidance
- arousal (for more than one month) ex. sleep difficulties, difficulty concentration, physiological responses
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OCD - obsessions definition
- unwanted repetitive, intrusive thoughts, ideas, impulses, or images
- in school aged children —> commonly involve fear of harm, separation, concerns with symmetry/correctness
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OCD - compulsions definition
- repetitive, stereotyped behaviours that the child feels compelled to perform
- meant to reduce anxiety associated with an obsession
- children and adults tend to have multiple compulsions
- compulsions fall into two broad themes: cleanliness and adverting danger; pervasive doubting
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OCD prevalence
- average age of onset: 9-12 years
- distribution bimodal
- children with early onset likely have a family history of OCD
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Genetic influences of anxiety disorders
- children with a family history of anxiety = increased
- genetic loading may produce difference in neurotransmitter systems (ie. serotonin and GABA)
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Physiological influences of anxiety disorders
Hypothalamic pituitary adrenal axis (HPA) and amygdala
- controls cortisol release
- chronic elevations in cortisol are detrimental
PANDAS
- autoimmune disorder where if they get a strep infection, they develop OCD-like symptoms
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Temperament influences on anxiety disorders
-the biologically based inherited differences in emotional behavioural style
Kagan (1997) linked anxiety disorders to temperament
- behavioural children are likely to withdraw from unfamiliar people or events
- behavioural inhibited children show more fears
- greater risk for developing anxiety disorders
Gray (1987) described the behavioural inhibition system
Clark & Watson described the negative affectivity
Lonigan et al. (2004) described effortful control
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Psychosocial influences of anxiety disorders
Three pathways:
- conditioning, observation, direct transmission —> learned fears and phobias
Parenting styles:
- parents of anxious children —> experience, perception of control
- authoritarian parents impose more anxiety on children
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Assessment of anxiety disorders
Include considerations into the tripartite model of anxiety
- examines behavioural, cognitive, and physiological symptoms
Clinical interviews
- ex. Structured interviews - kSADs or AIDS-CP
Self report measures
- MASC - multidimensional anxiety scale for children
- STAI - state-trait anxiety inventory for children
- negative affect self statement questionnaire
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Interventions for anxiety disorders - exposure based treatments
Effecting in treating phobias of spiders, thunder, lightning, water, heights, flying, enclosed places, choking, dental treatments, blood (needles)
Requires: longer sessions, frequency, daily sessions with more spread out sessions by the end of treatment, should be done under different contexts
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Exposure, relaxation, and modelling (interventions for anxiety disorders)
Exposure: an essential element to fear reduction and anxiety treatment programs
Relaxation: teaches child/adolescent to attend to their physiological reactions to anxiety, recognizing early signs of anxiety, control the reactions
Modelling: child observes another child interacting and coping with a feared situation
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Contingency management (intervention for anxiety disorders)
Pairs the anxiety provoking situation with rewards following exposure
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Cognitive restricting (intervention for anxiety disorders)
CBT
The goals in working with an anxious child are:
- to recognize the signs of anxious arousal
- to identify the cognitive processes associated with anxious arousal
- to employ strategies and skills for managing anxiety
Exceptional children
flashcards
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