exam_2_study_guide___clp4134.pdf CLP 4134
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This 26 page Study Guide was uploaded by Victoria Carter on Wednesday June 15, 2016. The Study Guide belongs to CLP 4134 at Florida State University taught by Matt Lerner in Summer 2016. Since its upload, it has received 8 views. For similar materials see Abnormal Child Psychology in Psychlogy at Florida State University.
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EXAM 2 study guide – CLP4134 CH 4 BOOK ONLY Be familiar with Felicia’s case presentation (p.83, more details throughout the chapter). It will be used frequently as part of inclass examples. A similar case presentation (with different details) will be part of the exam. Specifically, what is her presenting problem? What factors in her family and school environment are relevant to her current symptoms? Felicia, age 13 presenting problem: depressive symptom, including social withdrawal and sleep disturbance family & environmental stressors: o Mom hospitalized for pneumonia 1 yr ago, same as symptom onset o requests to be close to Mom too often (e.g., chores, hw) school: o refusal, claims stomach pain o social withdrawal o grades bc/d reports social rejection, hopelessness Clinical Issues 2. What is the purpose of clinical assessment? What types of information are gathered during clinical assessment? How is that information used? DecisionMaking Process have to decide if problem needs treatment, or likely to remit in time clinical assessment o seek to understand child in context of own environment o cognitive, emotional, behavior, environmental factors o valid assessment techniques o testing and revising hypotheses about diagnosis and how that relates to life circumstances diagnosis / treatment relation o main goal of diagnosis is to guide treatment o ongoing process o treatment ideally reduces symptom & impairment 3. Define idiographic and nomothetic case formulation. How are they different? Be prepared to recognize an example of each. idiographic vs. nomothetic case formulation o idiographic is info specific to child & environment o nomotheic is about the diagnosis in general, gives info that guides specific case formulation e.g., assessment, normal & abnormal child & family, diagnosis o process usually starts with assessment, including info from P, T, child Developmental Considerations 4. How do a child’s age, gender, and culture influence diagnostic and treatment decisions? Age school refusal large problem b/c academic & social fear of airplanes inconvenient but nbd Gender girls less likely to be referred for treatment o b/c int less noticeable to adults o e.g., faster rate of increase in ADHD prevalence in 1990s for girls than boys o seems unlikely, so more likely change in reporting Symptom type could be expressed differently by gender, aggression as an example o relational aggression: “verbal insults, gossip, ostracism, getting even…third party retaliation” o most commonly, aggression has to do with social exclusion predictive value differs based on gender o less typical forms of aggression are more predictive of future problems o e.g., physical for girls, relational for boys Culture threepart definition: o patterns of learned behavior and values; o shared among members; o distinguish members of one group from another e.g.: ethnicity, language, religious/spiritual, race, gender, SES, age, sexual orientation, geography, education, major life experiences higher risk of misdiagnosis among ethnic / cultural minorities o afam adolescents more likely organic/psychotic diagnosis than mood anx o afam / e▯ licia ▯adults less likely to get treatment than white requires clinician to examine own cultural beliefs value of cultural info o relationship / valid info from family o motivation o compatible treatment importance of cultural context o some coping behavior considered appropriate in some cultures isn’t in others, judge wrt child’s culture not clinician’s o stigma of diagnosis or treatment may vary, be aware and know how to minimize o low acculturation could bias clinician toward seeing smg (behavior, cog, emo) as symptom o cultural values influence what treatment goals will be accepted vs. not 5. What is “normative information” and what is its importance to clinical assessment? Normative Information - Most symptoms are actually common - most kids have probably knocked over a chair because they are hyper, but most don’t do it constantly like someone with ADHD might same behavior, even when causes impairment, could be considered symptom or not depending on context think of Felicia o maybe the clingy behavior isn’t surprising o but not the sleep disturbance is normal reaction, given separation from parent isolated symptom usually transient, esp. when ageappropriate most symptom that result in referral are common in children w/o diagnosis—why? o frequency, intensity, duration o pattern matters, too pattern and ageinappropriateness are more predictive Purposes of Assessment 6. Define “description” and “diagnosis” as they pertain to clinical assessment. Description clinical description o behavior, cog, emo that cause impairment o usu. Parent & child report o emphasis on how these differ from children of same gender, age culture three main components o Intensity (of excessive or deficient behavior); frequency; severity o age of onset & duration o full description of symptom, how appear to be related Diagnosis taxonomic: formally assign a diagnosis label, if one fits problemsolving: environment factors and other possible causes, what might impact treatment 7. What are the two primary purposes of clinical assessment? Prognosis & Treatment Planning Prognosis: [evidencebased] predictions wrt likely outcomes w/o treatment or w/ specific treatment important not to pathologize or dismiss incorrectly cost of wrong prognosis: problem could get worse, miss out on certain interactions bc of wrong diagnosis treatment planning is o choice of treatment (research evidence) and o evaluation / changes of treatment (individual evidence) should continue to measure symptom, look for other things that might need to be measured o e.g., what operant conditioning is happening w/ e▯ licia o (M does hw, keeps home from school w/ stomach ache) Assessing Disorders 8. What is the “multimethod approach” to diagnostic assessment, and what are three key components of this approach? Multimethod approach: o d: various informants, settings, methods (interview, observation, questionnaire, tests) o some symptom are more amenable/cooperative to one or another interviews o good first step, esp. when figuring out what to ask more systematically about o may separate child and parent/s measures o e.g., assessment, checklist, rating scale o choices guided by presenting problem, info in interview Clinical Interviews 9. What is a clinical interview? What are its strengths and weaknesses? usually minimal structure, key is to find out what to assess more systematically later can provide info about pc interactions important topic areas o developmental history o likes/dislikes o behavior s&w o discipline style / child response o child’s relationships w/ adults, peers o academic performance consider child age, esp when deciding to include parent or not 9a. What is a semistructured interview, and what tradeoffs does it involve? Semistructured Interviews greater reliability, designed to elicit specific information not totally scripted, can follow up as appropriate have to balance between benefits of standardization and being too rigid / reduce comfort level of child 10. BOOK ONLY What information is usually included in a developmental or family history? Developmental and Family History major events in child’s life and family during child’s life usu includes o birth & related events, including drug use or other toxins during pregnancy o physical milestones (e.g., walking, language, bladder & bowel, selfcare) o medical hx, incl injury, illness, rx, surgery o family hx incl demographic, occupational, medical o child’s interpersonal w/ adults & peers o education hx o if older, work and relationship hx o describe presenting problem now and previous, incl previous treatment o parents’ and child’s expectations of treatment develop hypotheses about risk & protective factors that may help with treatment choice or implementation 11. What is the purpose of behavioral assessment and how is it accomplished? Behavioral Assessment interviews are a good start, but often need to see symptom and imp in setting where they occur d: assessment of cog, emo, behavior in situ and use this info to form hyp about diagnosis and treatment advantage: direct, see actual context, avoid recall bias and other reporting problems disadvantage: observer effects, small slices esp. for lowfrequency behavior, can’t observe cog / emo ABCs (think of this in terms of conditioning models) o antecedents o behavior of interest o consequences or things that tend to occur after Felicia o A: time for school o B: reports stomach pain o C: M allows to stay home from school 2 y/o o A: bedtime o B: tantrum o C: delay of bedtime goal of functional analysis of behavior o determine wide range of possible influences on target behavior o systematically test them o often start with easiest to manipulate 11a. What types of standardized paperbased behavioral measures exist? Know specifics about the CBCL. Child Behavior Checklist (CBCL) is a widely used method of identifying problem behavior in children. checklists & rating scales o report can be child, P or T o standardized, so easier to answer questions about how unusual behavior is compared to peers o observers can disagree, and it may mean behavior differs by setting o can be specific to a diagnosis or behavior; others assess a broad range of behavior types (e.g., CBCL) CBCL (Achenbach & Rescorla, 2001) o parent version for ages 618 o also T, C, obs, interview; can use any one or combination o quantifies symptom in 8 categories Behavior observation & recording o start before treatment, to see if it is working o either clinician or parent o observer effects; no method is perfect 12. SOME PORTIONS BOOK ONLY What is psychological testing in general? What information do various types of tests (developmental, intelligence, projective, personality, neuropsychological) provide? Psychological Testing (general) d: task or set of tasks, standardized procedures & scoring, to measure knowledge, skill, or py/temperament standardization or “norming” sample provides comparison group o may be similar to that child, offer different norms for different groups o may be narrow sample, less similar to some children o esp. problematic for IQ or achievement tests if e▯ licial▯y biased limit bias by using diverse norming group, carefully creating items w/o culturally biased content reducing bias is a matter of internal validity (if cultural difference and not IQ or symptom difference, lower validity) Developmental Testing d: psych test to determine what dev milestones have / haven’t been reached, compare to norms by age screening: faster, less detailed, determine risk status, indicates need for further testing (or not) Intelligence Testing important b/c treatment for poor acac is very different if cause is IQ vs impairment from depression symptom Intelligence is difficult to define, debate remains Weschler “the overall capacity of an individual to understand and cope with the world around him” various tests have s&w WISCIV 10+6 tests; age 616 years reduces possible cultural bias by reducing emphasis on info instead fluid reasoning examples: highlytrained examiner, very specific responses, clarifications depending on child’s response FSIQ = verbal comprehension, perceptual reasoning, working memory, processing speed overall score is best predictor of educational outcomes (i.e., criterionrelated validity) pattern can suggest areas of relative strength & weakness for a particular child, large differences b/w subscales are unusual, but do occur 13. BOOK ONLY What is projective testing and why is it controversial? Personality Testing d: enduring pattern of traits that characterize how the individual interacts with the environment temperament interacts with environment, forms personality Big 5 (ask how these map onto PE, NE, EC o Extraversion (outgoing, energetic) o Agreeableness (sympathy, affection) o Openness to experience (wide range of interests, imaginative) o Conscientiousness (organization, planning) o Neuroticism (anxious, volatile moods) Neuropsychological assessment info about r/b brain and behavior often impossible or impractical to observe brain fx, so use tasks known to be controlled by certain parts of brain wide range of task types, presumably gives info about specific brain regions info more about functional s&w, not diagnosis 14. What is classification (with regard to mental illness) and why is it necessary? Classification and Diagnosis classification: system to represent categories or dimensions of psychopathology, and boundaries and relations among them why isn’t it enough to look at every individual w/o labeling as part of a group o causes o treatment 15. What are the key features of a categorical classification system? Categories & Dimensions categorical o d: diagnosis has a clear cause and each diagnosis is fundamentally different from the others o problem is rarely describes all impairing symptom in a given case o diagnosis w/in a category don’t always share same set of causes 16. What are the key features of a dimensional classification system? dimensional o d: many independent types of behavior, all present to varying degrees o instead of group of symptom w/ a label, o quantitative measure of multiple types of behavior o e.g., externalizing & internalizing 17. Compare and contrast dimensional and categorical classification systems. Specifically, what are the strengths and weaknesses of each? neither is necessarily “best,” each has s&w, which differ by diagnosis research of correlations (or predictors) often uses dimensional but treatment decisions often require categorical 18. What is the DSMV? What information does it provide? How is that information organized? What are “specifiers?” DSM diagnostic and statistical manual TR = text revision in 2000, new info from research findings multiaxial, various types of info about the child, symptom, fx, and env Axis 1: (most) clinical diagnosis or conditions Axis 2: permanent, lifelong o e.g., py diagnosis, intellectual disability o separated b/c may not otherwise get attention if Axis 1 diagnosis also present o py diagnosis rarely diagnosis until late adolescence Axis 3: general medical condition o could cause axis 1 diagnosis (sleep problemdepression; medical diagnosisanxiety) o think about temporal precedence in developing hypotheses about cause & effect (directionality) Axis 4: psychosocial and environmental stressors o can effect diagnosis, treatment, prognosis of Axis 1 or 2 o e.g., NLE, environmental problem, interpersonal stress o usu., just w/in last 12 mos, but longer if relevant to current symptom Axis 5: overall level of function o GAF 1100 o low is more impairment 19. SOME PORTIONS BOOK ONLY What valid criticisms are made against DSMV? Criticism of DSM notes symptoms, uses them to create categories, less about how symptom influence e/o more attention to adults than children little emphasis on situation / context child may not meet diagnosis exactly, harder to get services (e.g., not severe enough yet; clear symptom & impairment, but some from each of 2 or more diagnosis) 20. BOOK ONLY What are some “pros” and “cons” of diagnostic labels? Treatment 21. Define intervention, treatment, and prevention. How is each influenced by cultural factors? Intervention any procedure or set of procedures used to reduce or prevent symptoms and related impairment prevention: intv without specific symptom, usu for individuals selected on basis of risk factors Cultural Considerations most treatment for children don’t take culture into account important differences include o parenting beliefs o description of symptom cultural compatibility hypothesis: more compatible treatment more likely to work 22. What are three types of treatment goals? Treatment Goals child: reduce symptom and related impairment (social, academic) family: improved relationships, less conflict and stress societal: move social connections, less rule breaking 23. BOOK ONLY What minimal ethical standards apply to clinical work? APA minimal standards goals & treatment in client’s best interest (not clinician, school) participation is active, voluntary records to document effectiveness (or lack of) protecting confidentiality adequate qualifications of therapist 24. What are ethical issues that arise specifically in the treatment of children? On an exam, you would not be asked to list these issues. Instead, you might be asked to read a brief description of a presenting problem and determine which one(s) are relevant to it. Ethical issues with children competence to consent, refuse treatment confidentiality vs family interests is treatment enough for the problem? what about diagnosis that doesn’t have an evidencebased treatment for children? 25. What are the key features of each of the following general approaches to treatment: Psychodynamic BOOK ONLY, Behavioral, Cognitive, CognitiveBehavioral, ClientCentered BOOK ONLY, Family Neurobiological BOOK ONLY Hint: I’m not going to ask what medication is used for what diagnosis. General Approaches to Treatment more than 500 treatment for children exist (most with weak or no evidence) most therapists identify as “eclectic”, combining multiple treatment types Psychodynamic focus on unconscious and conscious conflicts become aware of these and how they contribute to symptom / imp then, resolve the conflicts months or years, back to earliest memories of important relationships assumes that resolving these problems will cause symptom / imp to remit little evidence; hard to disprove smg that can take years by definition e▯ licia: earliest days of rel w/ parents, mother’s illness, “fix” unconscious problems Behavioral abnormal behavior is learned use learning principles (e.g., operant conditioning) to learn more adaptive behavior can use classical conditioning too, e.g., systematic desensitization for phobia change sr contingencies in environment e▯ licia: don’t allow to stay home from school; reward social intreatment & bedtime Cognitive symptom result from patterns of thoughts e.g., deficit, bias, irrational expect that behavior and emo change as result of changed cog e▯ licia: challenge expectation of peer rejection, negative expectations, bias toward negative interpretation of social interactions CB thought patterns and learning experience together drive symptom combines cog & behavior approaches e▯ licia: more positive thoughts, try more social situations ClientCentered social or environmental factors impede growth of adaptive behavior empathy, unconditional acceptance less structured, nonspecific Family symptom & imp result from family system, not just individual change how family interacts to reduce symptom / imp e▯ licia: develop new, more independent role; fix marital conflict so parents can be more effective Neurobiological chemical imbalance causes symptom treatment is mostly pharmacological (medication) e▯ licia: antidepressant rx 26. What is treatment effectiveness and how is it determined? Treatment Effectiveness scientific approach: review of experimental evidence in the literature expert consensus approach: opinion where evidence isn’t available or conclusive, esp. wrt ext val across cultures 27. What evidence exists regarding the effectiveness of treatments for children? What ongoing work seeks to improve the treatments that are available to children? Good news (esp. for CB treatment) o in general, treatment is better than no treatment o this is true for 75% of treated (compared to nontreated) children, esp wrt symptom (not so much for imp) o treatment effects usually still present 6 mos after treatment ends o effects are ~2x larger for symptom targeted by treatment than symptom not targeted o more treatment, in general, more effective than less bad news o few treatments (<20%) that reduce symptom also reduce impairment o positive evidence above is efficacy, less evidence of effectiveness, perhaps b/c o more severe cases, less structure, less behavior (more psychodynamic / eclectic) Efficacy and Effectiveness Efficacy: impact with tight control (the extent that the experiment works in tightly controlled circumstance [lab]) Effectiveness: less control (the extent that the experiment works under less controlled circumstances [out in the real world]) CH 5 1. When was ADHD first described? [Book Only] 2. Other than specific symptoms, (which will be discussed below) what are the diagnostic criteria for ADHD? You may be asked to read a brief description and determine if a child meets criteria for ADHD. ADHD: persistent pattern of inattention (IA) and/or hyperactivityimpulsivity (HI) Severity 6+ symptoms (of either IA or HI) for 6+ months Atypical for children of same age Directly related to social or academic impairment Onset before age 12 Pervasiveness (the disorder shows up in a lot of places in the kid's life because ADHD is a neurological disorder so the disorder can't show up during school and not during soccer practice because it's in the brain) Not better accounted for by other diagnosis 3. What are the Inattention symptoms of ADHD? Difficulty (not inability) of at least one of the following (usually all): sustaining attention to a task following through on instructions completing tasks It's not that kid's with IA can't pay attention, they can't chose what they pay attention to can be confusing and less noticeable to adults kid paying attention to the mud puddle instead of the soccer game video games are common among IA because the video game captures attention and keeps changing the attention missed social cues Symptoms: Inattentive (need 6 need to recognize on test) Careless mistakes Difficulty maintaining focus Doesn't seem to listen Doesn't complete tasks after starting Difficulty with organization (time, materials) Avoid tasks requiring sustained effort Loses supplies Distracted by noises Forgetful in daily activities (ex. Self care) Attention Capacity (how much information can you hold in mind for a brief amount of time) NOT impaired for IA kids Selective Attention/Distractibility VERY impaired for IA kids Distractibility VERY impaired for IA kids especially for loud stimulus such as television, loud conversations, door slamming, etc. Sustained Attention (paying attention something for a long time that isn't interacting with you and not very stimulating, such as reading a novel; driving for hours) VERY impaired for IA 4. What are the Hyperactivity / Impulsivity symptoms of ADHD? Difficulty controlling body Overly energetic, notgoal directed (even during sleep) Largest (most noticeable) when required to sit still Difficulty with delay of gratification/considering consequences of action not sharing taking apart a complicated toy stopping a preferred activity when asked More accident prone than peers Symptoms: Hyperactive/Impulsive (need 6) Fidgets with hands or feet Leaves seat when expected to sit Runs or climbs inappropriately Unable to enjoy quiet activities Always "on the go" Talks excessively among peers Blurts out answers Difficulty taking turns Often interrupts conversations/activities Agerelated differences in H/I symptoms Fewer symptoms required to meet HI criterion 5. How and why are the criteria hyperactiveimpulsive symptoms different for older children and adults? Less common among older children so, 5, not 6 symptoms to meet this criterion (FOR OLDER CHILDREN/ADULTS) 6. What are the specifiers used with the diagnosis of ADHD? Specifiers are extensions to a diagnosis that further clarify the course, severity or special features of a disorder or illness. Specifiers: Primary symptom type primarily inattentive primarily hyperactiveimpulsive combined Changes in symptoms over time (changes in symptoms need to remain stable/not relapse) Severity (severity in ADHD is measured by number of symptoms) if someone only has 6 symptoms, that would be mild severity because out of a possible 9 symptoms, they only had 6 Evaluates severity of the impairment in the domain it shows up in (how bad the impairment is) 7. Define and describe the inattentive component of ADHD. 8. Name and describe four types of inattention (not symptoms, broad types). Which types are and are not impaired among children with ADHD? 9. Define and describe the Hyperactivity component of ADHD. 10. Define and describe the Impulsivity component of ADHD. 11. What are some limitations or weaknesses of the DSMV definition of ADHD? Age differences Arbitrary cutoff (need 6 symptoms ... But a child with 5 symptoms isn't that different than one with 6) 12. What does the term “associated characteristics” mean? something (ex. A trait or behavior) that is associated with, but not a symptom of a disorder 13. Define Executive Function. What are the two most commonlystudied components of Executive Function? How is each measured? How might each of these components influence social interactions? Executive Function: coordination of basic cognitive skills in service of a goal 2 most common components of Executive Function Working Memory Inhibitory Control (effortful control) Both measured by common tests and practical use These components influence family conflict and peer relations 14. What characteristics are associated with ADHD in the following areas? What is known about each? 14.1 Intellectual Deficits 14.2 Academic "Positive illusory bias" Children with ADHD tend to overestimate their abilities More common with HI type > conduct problems (might think they know everything for a test without studying but they end up doing poorly) ADHD can cause bad study habits which causes academic impairment 14.3 Specific Learning Disorders Associated Characteristics: Specific Learning Disorders up to 45% with ADHD also have SLD Lower estimates have tighter definitions Reasons for ADHDSLD comorbidity? shared cause mediation (ADHD > study skills > academic impairment) 3rd variable may influence both (genetic?) 14.4 Distorted SelfPerceptions 14.5 Medical and Physical (Book only) 15. What social problems in the family and peer contexts are associated with ADHD? How are these associated features related to problems later in life? Associated Characteristics: Family Conflict Elicit harsh discipline (TRANSACTIONAL) bad behavior causes harsh discipline; harsh discipline frustrates child and causes behavior to happen more Parents may have ADHD More marital conflict, caused more by defiance, not IA or HI behavior themselves "Driven to drink" study: Parent with children who had hyperactive symptoms were driven (high tendency) to drink more Associated Characteristics: Peer Relations Awkward, ineffective social behaviors Don't recognize rule/social norm violations (don't recognize that talking over someone is bad) Cyclical problem annoying to peers fewer friends fewer chances to learn social skills Not a lack of social reasoning 16. What diagnoses are more likely among children with ADHD than among children with no diagnosis? (Hint: I’m not asking about bipolar disorder or “Developmental Coordination and Tic Disorders”) MOOD AND ANXIETY DISORDERS Comorbid Disorders: Mood & Anxiety Anxiety typical intent atypical intensity combination increases impairment Mood 2030% have depressive episode by adolescence social isolation (caused by ADHD) can lead to depression increased suicide risk, especially for girls cycle of isolation > depression > more isolation 17. What is known about the prevalence and course of ADHD? How do gender, SES, and culture influence these patterns? Not an epidemic Geographic differences 67% in U.S. (MEMORIZE) 5% worldwide (MEMORIZE) because most of the world uses ICD10 which is more stringent also because US diagnoses aren't as stringent about impairment factor Importance of multiple raters (need to get different perspectives, parents might be too strict and have high expectations, etc) Prevalence & Course of ADHD: Gender Differences Possible Reasons actual differences? HI more noticeable than IA (and boys are more active than girls) Difference decreases with age criteria were developed with boys Largest in clinical samples No gender difference in prognosis Prevalence & Course of ADHD: SES and Culture Higher risk if low SES Who gets diagnosed? if 2 groups of children have the same symptoms, African Americans are less likely to get diagnosis of ADHD than white children Equal treatment response (if 2 group of children get the same treatment, there are no differences in how/how well the treatment worked) Cultural differences in acceptability of behavior 18. What is known about the course of ADHD in general? the longer it is prevalent, the worse it can get later in life 18.1 During preschool, First "structured" environment How much is too much? Children aren't used to this environment Duration matters (ADHD type behavior, the longer it is prevalent, the worse it can get later in life) Effects on parents 18.2 elementary school, and Large increase in demand for selfregulation Academic & social difficulties More serious defiance begins (ODD, CD) 18.3 adolescence? Decreased H/I but still present for 50% even with remission, more H/I than 95% of peers Remaining H/I predicts poor outcomes 19. Many theories exist with regard the causes of ADHD. What information comes from each of the following areas? explanation that focuses on just ONE cause is likely to be INADEQUATE 19.1. Genetic influences (Book only) 19.2. Pregnancy, Birth, & Early Development Toxins, stress influence nervous system Especially alcohol and other drugs, but casual? 19.3. Diet, Allergy, and Lead Sugar is not related Some evidence for lead (but not all causes) 19.4. Family Influence, not the cause Heritability Symptoms and family conflict causal direction probably transactional (family conflict cause disorder and disorder cause family conflict) 20. What is known about the use of stimulants to treat ADHD? Stimulants most common Some children respond poorly medication can cause reduced appetite, unstable emotions, lack of sleep Effective* for 80% of children with HI ADHD (*these only show up in the area of reduced symptoms NOT reduced impairment) No longterm benefits (once they stop taking medication, the symptoms return) 21. Why is the use of stimulant medications for ADHD controversial? (Hint: I’m specifically asking about two things (a) overprescription, and (b) aspects of ADHD that medication does not help.) 300% increase since 1990 (a) might be due overprescribing/overdiagnosing (a) 5X higher prescription rate in US (a) Inconsistent diagnostic practices What does "effective" mean? Symptoms are reduced, but impairment is not (b) medication for IA type is much less effective 22. How is parent management training used in the treatment of ADHD? Typical strategies of parenting may not be effective (because ADHD kids respond differently) parents learn about characteristics of ADHD and how to manage behaviors build up warm/close/secure relationship with child so the child will respond better to parenting CH 9 1. What is known about externalizing behaviors among children who do not have conduct problems? In other words, what is known about the externalizing behaviors demonstrated by typical children? RuleBreaking Behavior Rule breaking is common, not always a symptom Many externalizing behaviors decrease with age Context matters ("Steve" case example in book!!! Read for test!!!) Steve says that he stabbed his father and stole the car. However, the context of the situation matters. His father had been aggressive and tried to hurt his mom so he stabbed him and stole the car to get away 2. From a social or economic perspective, what is the significance of externalizing behavior in general? [Book only] 3. From a legal perspective, how are conduct problems defined? What is a limitation of this perspective? [Book Only]. 4. How are the dimensions of “overtcovert” and “destructivenondestructive” used to describe externalizing behaviors? Be prepared to identify examples of each of four types of conduct problems (e.g., overtdestructive, overtnondestructive, etc.) Two main features (see figure 9.2!!! Read this!!) Overtcovert: on one axis is scale of overt behaviors (open/visible) to covert behaviors (hidden) destructivenondestructive: one other axis is scale from destructive to nondestructive ON EXAM, will have to identify which of the 4 (or combination??) a described behavior/situation is 5. From a psychiatric (or categorical) perspective, how are conduct problems defined? Distinct mental disorders; present or absent "persistent patterns of antisocial behavior" specific criteria make reliable diagnosis possible each disorder predicts different outcomes 6. What type of behaviors characterize Oppositional Defiant Disorder (ODD)? General “flavor”/attitude (UP YOURS!!) Age of onset typically detectible as early as preschool Impairment in social or academic area Predicts dysfunction later 7. How is ODD defined in DSM5? How are categorical and dimensional features included in this definition? Pattern of angry/irritable mood, Argumentative/defiant behavior, or vindictiveness Duration Number of symptoms Context; ODD behavior needs to be directed at someone OTHER THAN A SIBLING Example symptoms holding a grudge arguing with adults (probably take pleasure in arguing) frequently blaming others Vindictive: hurting other people on purpose Oppositional Defiant Disorder: Criteria Distress or impairment Not better explained Dimensional aspects specifiers for mild, moderate, & severe ODD (based on # of settings where symptoms show up) Look in book for other dimensional aspects!!! 8. How is conduct disorder (CD) defined in DSM5? How are categorical and dimensional features included in this definition? Conduct Disorder (CD) repetitive and persistent pattern of behavior in which basic rights of others or major ageappropriate societal norms or rules are violated at least 3 of 15 criteria in the past 12 months, with at least 1 in the past 6 months Impairment Categories of CD behaviors Aggression to people or animals Destruction of property (to hurt someone or building severely starting a fire) Deceitfulness or theft (stealing something while owner is watching) Serious violations of rules CD: Age of Onset Childhood onset younger than age 10 more boys more aggressive more persistent course Adolescent onset no sex differences less violent, less severe (buying alcohol underage, running away) less persistent course (likely that CD symptoms & behaviors will dwindle) 9. What is the significance of age of onset for children with CD? The earlier the disorder starts, the longer it will persist 9.1 How are ODD and CD related to each other? Comparing ODD & CD highly correlated, symptom overlap Age of onset differs Evidence of Distinction CD can occur without prior ODD ODD usually doesn't lead to CD 50% maintain ODD 25% remission of ODD 25% ODD > CD 10. With regard to IQ, how are children with ODD or CD similar toand different fromtypically developing children? What impact do these differences have on peer and family interactions? IQ Equal nonverbal IQ (than typically developing children) Lower verbal IQ Difficulty with pursuit of goals School Range of negative outcomes grades suspension/expulsion dropout Casual direction if you get ODD when you are 2 years old, school could not have cause the behavior. The behavior caused the problems at school Third variables 11. What associated features of ODD/CD can be observed in the school context? Do academic difficulties cause the behaviors associated with ODD/CD? School and ODD/CD behaviors can be transactional 12. What types of family factors influence the development of ODD/CD? Among these factors, which are proximal (more immediate) versus distal (farther away) influences on children? General or Indirect DISTAL parent mental health problems marital discord antisocial role models Specific or Direct PROXIMAL hard discipline inconsistent discipline lack of supervision 13. How do the peer interactions of children with ODD/CD differ from the peer interactions of typically developing children? Aggressive, even during preschool More social rejection, but some friends (usually have friends who display similar behavior) Effects of deviant peers Distorted social perception 14. Define, compare, and contrast reactive and proactive forms of aggression. Reactive usually in response to some provocation associated with low selfregulation Hostile Attribution Bias: the tendency to interpret others' behaviors as having hostile intent, even when the behavior is ambiguous or benign. someone with ODD or CD will think that a person who accidentally bumped into them meant to hurt them and did it on purpose reacting to quickly and find themselves in a fight "I don't know why I keep ending up in these fights!" proactive usually to obtain a goal dominance more important than affiliation "Everyone knows I'm going to win this fight!" more planned out, actively seeking out a fight 15. Describe the cognitive bias demonstrated by children with ODD/CD. generate fewer solutions to social problems More likely to choose aggressive behavior Source of this bias: may have grown up around this kind of behavior never punished for these behaviors 16. How common is ADHD among children with ODD/CD? What are some possible reasons for this overlap? highly correlated (~50% with one, have both) Possible reasons shared vulnerability impulsivity magnifies many risks evidence of distinction 17. How common are internalizing symptoms (i.e., depression and anxiety) among children with ODD/CD? highly correlated (~50%) Not al antisocial behaviors Levels of severity also correlated 18. Compare and contrast the lifetime prevalence rates of ODD and CD. [Book only] 19. What gender differences are noted in the prevalence of CD? Gender ratios (more common in boys than girls) Still present in girls, especially for late onset 20. What possible explanations exist for the gender differences in CD? Apparent differences decreased 50% Physical vs. relational violence DSM5 emphasizes physical aggression Relation aggression harder to spot 21. What characteristics, seen in the first years of life, are correlated with CD in older children? "Difficult temperament" irritable (think of high NE) don't need to memorize fussy (think of low PE) don't need to memorize Not specific to CD or ODD hindsight bias? 22. Describe the two most common developmental pathways of antisocial behavior. Why are some children more likely to be on one pathway, as opposed to the other? (Hint: I’m not asking about adult outcomes.) Pathways: Adolescent Limited CONDUCT DISORDER about 50% of cases Less severe symptom Less pervasive (symptoms show up in less environments) maybe symptoms show up at school, not at home Onset during puberty Stronger family ties (direction?) Still a risk for dropout etc. Pathways: Life Course Persistent CONDUCT DISORDER About 10% of cases Earlier onset Behavior change with opportunity (Example: 6 year old can't really steal from mall because they are with their parents, but a 12 year old can; if child sees opportunity to hurt an animal and taking pleasure in hurting animals repeatedly, can lead to violence against people) childhood middle childhood adolescence CD and Multifinality MULTIFINALITY: some kids end up with limited CD or persistent CD Individual Factors neurological (I.e. Brain based) factors language ability, regulation of temperament, delayed gratification less extreme symptoms vulnerability to environment Family & Social Factors SES fewer delinquent friends fewer parent mental health problems, especially similar antisocial behaviors 23. Can any single theory account for all antisocial behavior? If not, what type of theory would be necessary? NO. 24. How strong is the genetic influence on antisocial behavior? What are two possible mechanisms for this influence? Contributing Causes of Antisocial Behavior: Genetic 50% genetic contribution, nonspecific Persistent vs. Limited more genetic influence in Lifecourse/persistent disorder than limited Possible pathways genes could influence the sensitivity toward others emotions genes could influence temperament genes could influence exposure or vulnerability to risk environment 25. How can prenatal factors or birth complications influence the probability of antisocial behaviors? [Book only]. 26. How can neurobiological factors influence the probability of antisocial behavior? [Book only]. 27. Define “socialcognitive abilities.” In what ways are these abilities impaired among children who demonstrate antisocial behaviors? socialcognition: attending to, interpreting, or responding to social cues Often impaired in CD Language and effortful control Hostile attribution bias: think that people are doing everything to hurt you. If someone accidentally bump into you, you believe they did it on purpose always expecting the worst in people Less accurate in recognition of facial expressions (anger, surprise, sadness, disappointment) might be the reason why they lack empathy, they can't register emotional cues of others 28. How are parenting behaviors related to antisocial behavior, among children who have genetic risk for antisocial behavior? Contributing Causes of Antisocial Behavior: Parenting Behaviors Moderator of genetic risk if parents of CD kids use effective parenting, it will lessen the effects of the genetic dispositions of antisocial behavior Marital conflict Transactional relation inconsistent or harsh parenting might teach a child to display antisocial behaviors parenting could be a cause or a response to the antisocial behavior Genetic influence as third factor (genetic factors could cause both the harsh parenting and the antisocial behavior of the child) 29. Define coercion theory. What does it have to do with the reciprocal influence between children who engage in antisocial behaviors and their parents? Coercion Theory: process of mutual reinforcement during which caregivers inadvertently reinforce children's difficult behaviors, which in turn elicits caregiver negativity, and so on, until the interaction is discontinued when one of the participants “wins.” Not separate from genetic and environmental risk factors Based on operant conditioning Both parent and child are using positive punishment to get what they want (coercing each other to behave the way they want parent scolds child child argues parent withdraws child stops arguing can escalate to physical violence when child gets older Coercion theory has proximal effect on antisocial behavior 30. How can neighborhood characteristics influence the probability of antisocial behaviors? All indirect (distal) influences Violence (witnessed or experienced) Selfselection: people chose to live in places where their antisocial behaviors are seen as normal so they aren't bothered or questioned about their behavior Lowquality schools: kids at low quality schools usually can't get a good job after graduation. When kids in low quality schools start to realize this, they chose to have fun and skip class and get in fights instead of getting an education because they know that an education probably won't help them get a good job Some formal causal evidence for school effects 31. How can exposure to media violence influence the probability of antisocial behaviors? [Book only]. 32. How can cultural differences influence the probability of antisocial behaviors? [Book only].
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