PSY 306 - PSYCHOPATHOLGY

CHILDHOOD DISORDERS

OVERVIEW OF LECTURE

• ATTENTION DEFICIT HYPERACTIVITY DISORDER

• CONDUCT PROBLEMS• ANXIETY DISORDERS• DEPRESSION• OTHER DISORDERS

DIFFERENCES BETWEEN INTERNALISING AND

EXTERNALISING DISORDERS

EXTERNALISING• DISRUPTION,

AGGRESSION, AND ANGER

• DISRUPTIVE TO OTHERS

• CLEAR OVERT BEHAVIOURS

INTERNALISING• WITHDRAWAL,

AVOIDANCE, AND DISTRESS

• DISTRESSING TO SELF

• LESS CLEAR OVERT BEHAVIOURS

SYMPTOMS OF AD/HD BARKLEY ET AL. (1990)

SYMPTOM AD/HD % NONCLIN. %FIDGETS 73 11DIFFICULTY SITTING 60 3EASILY DISTRACTED 82 15DIFFICULTY WAITING 48 5BLURTS OUT ANSWERS 65 11DIFFI. FOLLOWING INSTRUCT. 84 12DIFFI. SUSTAINING ATTENTION 80 17UNCOMPLETED TASKS 77 17DIFFI. PLAYING QUIETLY 40 8TALKS EXCESSIVELY 44 6DOESN’T LISTEN 81 15LOSES THINGS 63 12PHYS. DANGEROUS ACTIVITIES 37 3

37

DIFFERENCES BETWEEN AD/HD AND CONDUCT DISORDER

HINSHAW (1987)

• AD/HD NOT RELATED TO LOW SES• AD/HD NOT RELATED TO PARENT

PSYCHOPATHOLOGY• AD/HD NOT RELATED TO MARITAL

INSTABILITY

PROBLEMS IN ADULTS WITH HISTORY OF AD/HD

MANNUZZA ET AL. (1993)

AD/HDSYMPTS.

ANTISOC.PD

DRUGABUSE

02468

1012141618

AD/HDSYMPTS.

ANTISOC.PD

DRUGABUSE

AD/HDCONT.

INDICATORS OF SUBTLE BRAIN DYSFUNCTION IN AD/HD

• ABNORMAL EEG’s

• NEUROLOGICAL SOFT SIGNS

• FRONTAL LOBE DISTURBANCE

• ABNORMAL BRAIN SCANS

CASE OF OPPOSITIONAL DEFIANT DISORDER

PETER WAS A 15 YEAR-OLD SCHOOL BOY WHO LIVED WITH HIS MOTHER, FATHER, AND 14 YEAR-OLD SISTER. PETER’S PARENTS BROUGHT HIM FOR TREATMENT BECAUSED OF WHAT THEY DESCRIBED AS HIS NONCOMPLIANCE, MAKING LIVING WITH HIM IMPOSSIBLE. ACCORDING TO THEM, THERE WERE THREE MAJOR TYPES OF PROBLEMS:

1) A REFUSAL TO OBEY ANY INSTRUCTIONS; 2) CONTINUOUS USE OF OBSCENE WORDS; 3) ABUSE OF HIS MOTHER, INCLUDING SWEARING, CUTTING UP ONE OF HER DRESSES, AND THREATS OF PHYSICAL ATTACK.

INTERESTINGLY, THE NONCOMPLIANCE ONLY APPEARED WITH PETER’S PARENTS AND WAS NOT EVIDENT AT SCHOOL OR AT FRIEND’S PLACES.

THE DISCIPLINE PROBLEMS HAD BUILT GRADUALLY OVER THE PAST 5 YEARS, IN PARTICULAR AS PETER GREW BIGGER. THEY REPORTED THAT PETER WAS VERY PERFECTIONISTIC AND WAS ESPECIALLY AGGRESSIVE AND CONTEMPTUOUS OF ANYONE HE PERCEIVED AS LESS INTELLIGENT THAN HIMSELF.

CASE OF CONDUCT DISORDER

JOHN WAS A 15 YEAR-OLD BOY WHO WAS BROUGHT TO THERAPY BY HIS MOTHER IN ORDER TO “GET HIM BACK INTO SCHOOL”. JOHN HAD BEEN EXPELLED FROM HIGH SCHOOL AFTER BEING CAUGHT BREAKING INTO THE SCHOOL TUCK SHOP WITH A GROUP OF OTHER BOYS. HE HAD PREVIOUSLY BEEN CAUGHT STEALING MONEY FROM CHILDREN’S BAGS AND HAD A HISTORY OF STEALING MONEY FROM CARS, SHOPS, AND HIS PARENTS. JOHN HAD ALSO BEEN TRUANT ON MANY OCCASIONS FROM SCHOOL AND HAD BEEN IN A NUMBER OF FIGHTS.

OUTSIDE SCHOOL, JOHN REPORTED THAT HE HAD NO REAL INTERESTS AND WOULD SPEND MOST OF HIS TIME “HANGING AROUND WITH THE KIDS” IN THE STREET. THE GROUP OFTEN BECAME STONED, DRUNK, OR SNIFFED PETROL. JOHN ADMITTED THAT HE SOMETIMES CARRIED A KNIFE WHEN HE WENT OUT BECAUSE HE “DIDN’T WANT TO BACK DOWN FROM ANYONE”. THERAPY WAS VERY DIFFICULT BECAUSE THE THERAPIST SUSPECTED THAT THERE WERE MANY THINGS THAT JOHN WAS NOT ADMITTING AND THAT MANY STORIES DESCRIBED BY JOHN WERE GROSSLY EXAGGERATED.

MAJOR PREDICTORS OF DELINQUENCY

LOEBER (1990)

• POOR SUPERVISION• PARENT UNINVOLVEMENT• POOR DISCIPLINE• PARENT REJECTION• PARENT CRIMINALITY AND AGGRESSION• MARITAL PROBLEMS• PARENT ABSENCE• SOCIOECONOMIC STATUS• DEVIANT PEERS

PARENTING IN CD KIDS

• MORE PUNISHMENT

• HARSHER PUNISHMENT

• OPEN AND POORLY DEFINED INSTRUCTIONS

• MORE REJECTING AND HOSTILE

• INCONSISTENT

MODEL OF PARENT-CHILD INTERACTION - PATTERSON

PARENT NAGGING

CHILD REFUSAL

PARENTAL THREAT

CHILD TANTRUM

PARENT WITHDRAWAL

DEVELOPMENT OF AGGRESSION PATTERSON ET AL (1989)

REJECTION BY NORMAL

PEERS

CONDUCT PROBLEMS

POOR PARENTAL DISCIPLINE AND

MONITORING

ACADEMIC FAILURE

COMMITMENT TO DEVIANT PEER GROUP

DELINQUENCY

EARLY CHILDHOOD

MIDDLE CHILDHOOD

ADOLESCENCE

ATTRIBUTIONS RE PEERS’ INTENTIONS

DODGE & FRAME (1982)

AGGR. NONAGGR.

1.25

1.3

1.35

1.4

1.45

1.5

AGGR. NONAGGR.

SELF-DIRECTEDOTHER DIRECTED

HOSTILE ATTRIBUTION

BENIGN ATTRIBUTION

FAMILY FACTORS IN CD

INCONSISTENT DISCIPLINE

CHILD TEMPERAMENT

PARENT PSYCHOPATHOLOGY

EXTERNAL STRESSORS

LACK OF SUPPORT

CASE OF SEPARATION ANXIETY DISORDER

SARAH WAS A 13 YEAR-OLD SCHOOL GIRL WHO WAS BROUGHT TO OUR CLINIC BECAUSE OF A NUMBER OF FEARS AND WORRIES, ESPECIALLY RELATED TO BEING ALONE. THE MOST PRESSING PROBLEM WAS HER DIFFICULTY GOING TO SCHOOL. EVERY MORNING SARAH WOULD BE DROPPED OFF OUTSIDE THE SCHOOL BY HER MOTHER. ON MOST OCCASIONS, SHE WOULD CRY AND REFUSE TO GET OUT OF THE CAR. SARAH REPORTED THAT SHE WAS AFRAID THAT HER MOTHER (WHO WAS A NURSE ON NIGHT SHIFT) WOULD BE ATTACKED WHILE SHE SLEPT AT HOME.

ON TWO OCCASIONS AFTER HER MOTHER HAD PUSHED

OUT OF THE CAR IN THE MORNING, SHE RAN AFTER THE CAR THROUGH THE MORNING TRAFFIC. ON SEVERAL OCCASIONS SARAH HAD LEFT SCHOOL AND WALKED HOME DURING THE DAY AND SHE OFTEN REPORTED STOMACH CRAMPS AND WENT HOME. IN ADDITION TO THE SCHOOL REFUSAL, SARAH WOULD NOT GO TO SLEEP AT NIGHT UNLESS HER MOTHER WAS BESIDE HER, WOULD NOT ALLOW HER PARENTS TO GO OUT, AND WOULD NOT SLEEP OVER AT OTHER PEOPLE’S HOUSES. APART FROM THE WORRIES, SARAH WAS QUITE SHY AND HAD FEW FRIENDS, HAD A STRONG FEAR OF DOGS, AND REPORTED OFTEN FEELING DEPRESSED.

PERCENT OF KIDS WITH TWO OR MORE ANXIETY DISORDERS

BIEDERMAN ET AL. (1993)

B'LINE 3 YR F/U0

5

10

15

20

25

30

35

40

B'LINE 3 YR F/U

BINO BI

ANXIETY IN PARENTS OF BI KIDS ROSENBAUM ET AL. (1991)

0

5

10

15

20

25

30

BI KIDSNON-BI KIDSNORMALS

OVERPROTECTION IN MOTHERS OF ANXIOUS KIDS

HUDSON & RAPEE (1997)

ANX NONCL0

1

2

3

4

5

6

INVOLVEMENTUNSOL. HELP

AVOIDANT RESPONSES AFTER FAMILY DISCUSSION BARRETT ET AL. (1996)

0

10

20

30

40

50

60

70

ANXIOUS ODD NONCLIN

BEFOREAFTER

HOSTILITY IN PARENT-CHILD INTERACTIONS PRE AND POST TX.

PUIG-ANTICH ET AL. (1985)

MOTHER FATHER MOTHER FATHER0

0.5

1

1.5

2

2.5

MOTHER FATHER MOTHER FATHER

DEPRESSEDOTHERNONCLIN.

PRE-TX. POST-TX

COMMON TICS IN TOURETTE’S SYNDROME

MOTOR TICS - E.G.• ECHOKINESIS - IMITATION OF OTHERS’

MOVEMENTS• COPROPRAXIA - OBSCENE GESTURES

VOCAL TICS - E.G.• COPROLALIA - INVOLUNTARY UTTERING

OF OBSCENE WORDS• ECHOLALIA - REPETITION OF WORDS