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ADHD, ODD,

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ADHD, ODD, & CD Disorders of childhood Nature of Developmental Psychopathology: An Overview Normal vs. Abnormal Development Developmental Psychopathology Study of how ... – PowerPoint PPT presentation

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Title: ADHD, ODD,


1
ADHD, ODD, CD
  • Disorders of childhood

2
Nature of Developmental Psychopathology An
Overview
  • Normal vs. Abnormal Development
  • Developmental Psychopathology
  • Study of how disorders arise and change with time
  • Disruption of early skills can affect later
    development
  • Developmental Disorders
  • Diagnosed first in infancy, childhood, or
    adolescence
  • Attention deficit hyperactivity disorder (ADHD)
  • Learning disorders
  • Autism
  • Mental retardation
  • Conduct Disorder/Oppositional Defiant Disorder

3
Attention Deficit HyperactivityDisorder (ADHD)
An Overview
  • Nature of ADHD
  • Central features Inattention, overactivity, and
    impulsivity
  • Associated with numerous impairments
  • Behavioral
  • Cognitive
  • Social and academic problems
  • DSM-IV and DSM-IV-TR Symptom Types
  • Inattentive type
  • Hyperactive type
  • Impulsive type

4
ADHD Facts and Statistics
  • Prevalence
  • Occurs in 6 of school-aged children
  • Symptoms are usually present around age 3 or 4
  • 68 of children with ADHD have problems as adults
  • Gender Differences
  • Boys outnumber girls 4 to 1
  • Cultural Factors
  • Probability of ADHD diagnosis
  • Greatest in the United States

5
The Causes of ADHD Biological Contributions
  • Genetic Contributions
  • ADHD seems to run in families
  • DRD4, DAT1, and DRD5 genes have been implicated
  • Neurobiological Contributions
  • Smaller brain volume
  • Inactivity of the frontal cortex and basal
    ganglia
  • Abnormal frontal lobe development and functioning
  • Precise neurobiological mechanisms remain unclear
  • The Role of Toxins
  • No evidence that allergens and food additives are
    causes
  • Maternal smoking increases risk

6
The Causes of ADHD Psychosocial Contributions
  • Psychosocial Factors
  • Can influence the nature of ADHD
  • ADHD children are often viewed negatively by
    others
  • Constant negative feedback from peers and adults
  • Peer rejection and resulting social isolation
  • Such factors foster low self-esteem

7
Biological Treatment of ADHD
  • Goal of Biological Treatments
  • To reduce impulsivity and hyperactivity
  • To improve attention
  • Stimulant Medications
  • Reduce core symptoms in 70 of cases
  • Examples include Ritalin, Dexedrine
  • Other Medications With More Limited Efficacy
  • Imipramine and Clonidine (antihypertensive)
  • Effects of Medications
  • Improve compliance in many children
  • Decrease negative behaviors in many children
  • Do not affect learning and academic performance
  • Benefits are not lasting following
    discontinuation

8
Behavioral and Combined Treatment of ADHD
  • Behavioral Treatment
  • Involve reinforcement programs
  • To increase appropriate behaviors
  • Decrease inappropriate behaviors
  • May also involve parent training
  • Combined Bio-Psycho-Social Treatments
  • Are highly recommended
  • Superior to medication or behavioral treatments
    alone

9
CD/ODD
  • Definitional issues
  • Subtypes
  • -verbal vs. physical
  • -instrumental vs. hostile
  • -proactive vs. reactive
  • -direct vs. indirect/relational----indirect may
    pertain to girls more than boys
  • -overt vs. covert
  • -This leads to even more confusion in the
    fielddifferent definitions of ASB and different
    subtypes lead to a messy situation

10
CD/ODD
  • DSM-IV DEFINITIONAL CRITERIA
  • - 4 subcategories of CD
  • -socialized vs. undersocialized
  • -aggressive vs. nonaggressive
  • -Oppositional Disorder
  • -variant of CD
  • -intended to capture the early manifestations of
    antisocial behavior

11
Developmental Norms
  • -oppositional and defiant symptoms are common
    during the preschool years but then decline
  • -those that do not exhibit the typical age
    related declines, ODD applies
  • -CD not the norm
  • -although increases in such behaviors are seen in
    early to middle adolescents with a steep increase
    for girls

12
Prevalence
  • -difficult to say, definitions have changed many
    times
  • -epidemiological studies sparse and definitions
    differ
  • -suspect reporting
  • -retrospective age of onset a problem
  • ODD
  • -prevalence rates have ranged from 1 to more
    than 20 with median of 3
  • CD
  • -prevalence rates range from 1 to slightly over
    10
  • -DSM-IV cites rates of 6-16 for males and 2-9
    for females

13
Developmental Trajectories
  • Developmental timing
  • -ODD emerges 2-3 years earlier than CD symptoms
  • -6 years is average for ODD and 9 for CD
    behaviors
  • ODD pattern could serve as a developmental
    precursor to CD
  • -ODD in middle childhood linked to CD in late
    childhood or early adolescence
  • -over 90 of CD kids had ODD but the majority of
    kids with ODD do not develop CD
  • -unclear what other diagnoses or impairments
    pertain to those with early ODD who do not
    progress to CD

14
Developmental Trajectories (contd)
  • Measures of antisocial behavior show considerable
    stability across the life span
  • The composition of antisocial acts change over
    the years

15
Comorbidity w/ ADHD
  • There is an overlap in criteria and behavior
    associated with CD and ADHD
  • Comorbidity is important because
  • CD-ADHD is more severe
  • Earlier onset of CD symptoms
  • More likely to continue to display ASB into
    adulthood

16
Comorbidity w/ Learning disabilities
  • Link between aggressive/delinquent behavior and
    academic underachievement is well noted
  • Complex developmental trajectory
  • Early on, underachievement linked to ADHD
  • Later, underachievement linked to ASB

17
Comorbidity w/ Internalizing disorders
  • Anxiety contradictory findings
  • Depression Significant comorbidity
  • Oppositional behavior during early childhood
    followed by internalizing difficulties is a
    significant predictor of substance abuse

18
Risk Factors Etiology
  • Genes
  • Genetic effect differ by type of ASB
  • Strongest for ADHD
  • Moderate for overt ASB
  • Relatively small for covert ASB
  • Comorbidity between ADHD and CD is quite
    heritable as well

19
Risk Factors Etiology
  • Psychobiology
  • Grays model
  • Weak BIS
  • Normal to Strong BAS
  • Testosterone research inconsistent
  • Cortisol may be implicated?

20
Risk Factors Etiologies
  • Family factors
  • Intergenerational linkages of ASB
  • Parental psychopathology
  • Paternal ASPD
  • Parental Substance Abuse
  • Maternal Histrionic PD
  • Parents aggression
  • Maternal depression
  • Family characteristics
  • Low levels of parental involvement
  • Poor supervision
  • Harsh and inconsistent discipline

21
The big question
  • Antisocial behavior is prevalent. However, a
    majority of individuals stop exhibiting
    antisocial behavior when they reach adulthood.
    What factors might differentiate between those
    who persist and those who do not?

22
Pattersons Idea
  • Parent-child interactions and training by deviant
    peers

23
Moffitt Lynams idea
  • Comorbidity between disorders leads to persistent
    antisocial behavior

24
Kochanska idea
  • Different types of discipline lead children who
    are high and low on temperament fear to develop
    conscience
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