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Lecture

PSY 325 OCT 5 2012.doc

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Department
Psychology
Course
PSY 325
Professor
Karen Milligan
Semester
Fall

Description
PSY 325 L4 NOTES 5/10/12 **IMPORTANTADDITIONAL STUFF CLASS #5: RESEARCH IN PSYCHOLOGICAL DISORDERS & CHILDHOOD DISORDERS TREATMENT RESEARCH LEARNING OBJECTIVES: 1. LEARN WHAT IS MEANT BY EVIDENCE-BASED PRACTICE. 2. BECOME FAMILIAR WITH KEY CONCEPTS USED IN TREATMENT RESEARCHAND MAIN TREATMENT DESIGNS. 3. UNDERSTAND THE PROS AND CONS OF DIFFERENT RESEARCH DESIGNS. EVALUATING TREATMENTS FOR PSYCHOLOGICAL DISORDERS –ACONTINUUM OFDATA EFFICACY- LOOKSAT TREATMENTS UNDER CONTROLLED CIRCUMSTANCES EFFECTIVENSESS- PROVIDES POSITIVE RESULTS INAUSUALOR ROUTINE CARE CONDITION THAT MAY OR MAY NOT BE CONTROLLED FOR RESEARCH PURPOSES BUT MAY BE CONTROLLED IN THE SENSE OF SPECIFICACTIVITIES ARE UNDERTAKEN TO INCREASE THE LIKELIHOOD OF POSITIVE RESULTS CASE STUDIES WITH DATA COHORT, PRE-POST TREATMENT QUASI-EXPERIMENTS EXPERIMENTS (RANDOMIZED CLINICALTRIALS OR SINGLE-CASE EXPERIMENTS) BEST CLINICAL EVIDENCE _____________________________________ UNCONTROLLED EFFECTIVENESS STUDIES (E.G., BENCHMARKED) QUASI-EXPERIMENTALEFFECTIVENESS STUDIES RANDOMIZED, CONTROLLED EFFECTIVENESS STUDIES TREATMENT RESEARCH: KEY CONCEPTS DEPENDENT VARIABLE (OUTCOME)- THE FACTOR BEING PREDICTED OR THE OUTCOME BEING MEASURED AS A RESULT OF THE PSY 325 L4 NOTES MANIPULATION INDEPENDENT VARIABLE (TREATMENT)- THE VARIABLE BEING MANIPULATEDAND BELIEVED TO AFFECT THE DEPENDENT VARIABLE TREATMENT (IV) OUTCOME (DV E.G., SYMPTOM) OTHER KEY CONCEPTS: • INTERNALVALIDITY -IS THE RESULT CONFIRMED TO BE FROM THE TREATMENTS ITSELFAND NOT OTHER VARIABLES • EXTERNALVALIDITY - GENERALIZATION CASE STUDIES (VALUEAND LIMITATIONS) CASE STUDIESARE VALUABLE IN THAT THEY: 1. PROVIDE RICH AND UNIQUE DETAILABOUTAN INDIVIDUAL (HELPS COMPLEX CASES) 2. CAN STUDY RARE PROBLEMS 3. HELPFUL FOR GENERATING IDEASAND HYPOTHESES CASE STUDIESARE LIMITED INSOFARAS: 1. FINDINGS ARE NOT VERY GENERALIZABLE (DON'T HAVE GOOD EXTERNALVALIDITY) 2. OBSERVATIONSAND THE CONCLUSIONS DRAWN LACK OBJECTIVITY 3. THEYARE HARD TO REPLICATE COHORT STUDIES AND CORRELATIONAL ANALYSIS CORRELATION COEFFICIENT- STATISTIC REFLECTING PSY 325 L4 NOTES STRENGTH OFASSOCIATION BETWEEN VARIABLES RANGING FROM ¤ + 1.00 (APERFECT POSITIVE CORRELATION) ¤ 0.00 (COMPLETEABSENCE OF RELATIONSHIP) ¤ -1.00 (APERFECT NEGATIVE CORRELATION) CORRELATION (STRENGTH OFTHE RELATION BETWEEN THE TWO VARIABLES)≠ CAUSATION STATISTICALSIGNIFICANCE- THRESHOLDAT WHICH WE CONCLUDE, WITHIN CERTAIN PARAMETERS, THAT THERE ISAREALRELATIONSHIPBETWEEN VARIABLES THAT CANNOT BE ATTRIBUTED SIMPLYTO CHANCE. • PVALUE- TELLS YOU WHETHER YOU CAN REJECT THE NULL HYPOTHOSIS EFFECT SIZE (ES)– MAGNITUDE OFTHE EFFECT ¤ SMALL D ≥ .2 ¤ MEDIUM D ≥ .5 ¤ LARGE D ≥ .8 EXPERIMENTALSTUIES QUASI-EXPERIMENTAL - NATURALLY OCCURING GROUPS RANDOMIZED CONTROLTRIAL - BRING INALLDIFFERENT PARTICIPANTAND RANDOMLY PICK WITHIN THE GROUP INVOLVE CONTROL AND MANIPULATION OFTHE IV TREATMENTAND CONTROLGROUP INCREASED INTERNALVALIDITY ALLOWS FOR MAKING CAUSEAND EFFECT STATEMENTS WHATARE SOME OFTHE BENEFITSAND LIMITATIONS OF RCTS IN CONDUCTED INACADEMIC SETTINGS? META-ANALYSIS • COMBINE ESACROSSALLSTUDIES TO DETERMINE STRENGTH OF RELATIONSHIPAND SIGNIFICANCE PSY 325 L4 NOTES • INCREASES POWER TO DETECT SIGNIFICANT EFFECTS WHEN SAMPLE SIZES FOR INDIVIDUAL STUDIESARE LOW • HELPFULWHEN THERE IS CONSIDERABLE VARIABILITY IN -FINDINGS CAN LOOKAT MODERATORS OF ES STRENGTH CHILDHOOD DISORDERS LEARNING OBJECTIVES • ADDRESS WHY IT IS IMPORTANT TOADDRESS CHILDREN • BECOME FAMILIAR WITH THE DEVELOPMENTAL PSYCHOPATHOLOGY MODELAND HOW THIS APPLIES TO HOW WE UNDERSTAND PSYCHOPATHOLOGYAND DEVELOPAND IMPLEMENT TREATMENT • PROVIDE AN OVERVIEW OFAFEW CHILDHOOD DISORDERS (YOUARE RESPONSIBLE FOR LEARNINGABOUT OTHERS COVERED IN THE TEXT). ̈ PREVALENCE OF CHILDHOOD DISORDERS PSY 325 L4 NOTES “MANY, IF NOT MOST, LIFETIME PSYCHIATRIC DISORDERS WILL FIRST APPEAR IN CHILDHOOD ORADOLESCENCE” (COSTELLO ETAL, 2005, P. 972). WHAT IS NORMALVS ABNORMAL IN CHILDREN? DEVELOPMENTAL PSYCHOPATHOLOGY • ̈ • DEVELOPMENTALPATHWAYS ◦ SEQUENCE AND TIMING OF PARTICULAR BEHAVIOURS AND RELATIONSHIPS BETWEEN BEHAVIOURS THAT OCCURS OVER TIME ◦ DEVELOPMENT ISANACTIVE AND DYNAMIC PROCESS ◦ UNDERSTAND THE COURSE OF NORMALANDABNORMAL BEHAVIOUR ̈ • CUMULATIVE STRESS (CICCHETTI & TOTH, 2005) • RESILIENCE, RISK, AND PROTECTIVE FACTORS • MULTIFINALITY - MULTIPLE WAYS YOU CAN END UP̈ • EQUIFINALITY - HAVEANUMBER OF FACTORS THATALLLEAD TO THE SAME BEHAVIOURAL PROBLEM UNDERSTANDING CHILDHOOD DISORDERS ASSUMPTIONS IN DEVELOPMENTAL PSYCHOPATHOLOGY (MASH & DOZIOS, 2003) • MANY FACTORS CONTRIBUTE TO DISORDERED PSY 325 L4 NOTES BEHAVIOUR • FACTORS CAN VARYAMONG INDIVIDUALS • INDIVIDUALS WITH THE SAME DISORDER MAY EXPRESS IN DIFFERENT WAYS (SHOW DIFFERENT SYMPTOMS) • PATHWAYS LEADING TOANDAWAY FROM DISORDERARE NUMEROUSAND INTERACT (NOT UNIDIMENSIONALAND STATIC). DSM –IV TR CRITERIAFORADHD PSY 325 L4 NOTES (6+ IN EITHER OR BOTHAREAS) INATTENTION • OFTEN DOES NOT GIVE CLOSE ATTENTION TO DETAILS OR MAKES CARELESS MISTAKES IN SCHOOLWORK, WORK, OR OTHERACTIVITIES. • OFTEN HAS TROUBLE KEEPINGATTENTION ON TASKS OR PLAYACTIVITIES. • OFTEN DOES NOT SEEM TO LISTEN WHEN SPOKEN TO DIRECTLY. • OFTEN DOES NOT FOLLOW INSTRUCTIONSAND FAILS TO FINISH SCHOOLWORK, CHORES, OR DUTIES IN THE WORKPLACE (NOT DUE TO OPPOSITIONALBEHAVIOR OR FAILURE TO UNDERSTAND INSTRUCTIONS). • OFTEN HAS TROUBLE ORGANIZINGACTIVITIES. • OFTENAVOIDS, DISLIKES, OR DOESN'T WANT TO DO THINGS THAT TAKE ALOT OF MENTAL EFFORT FORALONG PERIOD OFTIME (SUCH AS SCHOOLWORK OR HOMEWORK). • OFTEN LOSES THINGS NEEDED FOR TASKSANDACTIVITIES (E.G. TOYS, SCHOOL ASSIGNMENTS, PENCILS, BOOKS, OR TOOLS). • IS OFTEN EASILY DISTRACTED. • IS OFTEN FORGETFULIN DAILYACTIVITIES. HYPERACTIVITY • OFTEN FIDGETS WITH HANDS OR FEET OR SQUIRMS IN SEAT. • OFTEN GETS UPFROM SEAT WHEN REMAINING IN SEAT IS EXPECTED. • OFTEN RUNS ABOUT OR CLIMBS WHENAND WHERE IT IS NOTAPPROPRIATE (ADOLESCENTS ORADULTS MAY FEELVERY RESTLESS). • OFTEN HAS TROUBLE PLAYING OR ENJOYING LEISUREACTIVITIES QUIETLY. • IS OFTEN "ON THE GO" OR OFTENACTS AS IF "DRIVEN BYAMOTOR". • OFTEN TALKS EXCESSIVELY. IMPULSIVITY PSY 325 L4 NOTES • OFTEN BLURTS OUTANSWERS BEFORE QUESTIONS HAVE BEEN FINISHED. • OFTEN HAS TROUBLE WAITING ONE'S TURN. • OFTEN INTERRUPTS OR INTRUDES ON OTHERS (E.G., BUTTS INTO CONVERSATIONS OR GAMES). • SOME SYMPTOMS THAT CAUSE IMPAIRMENT WERE PRESENT BEFORE AGE 7 YEARS. ADHD IMPAIRMENT • SOME IMPAIRMENT FROM THE SYMPTOMS IS PRESENT IN TWO OR MORE SETTINGS (E.G. AT SCHOOL/WORKANDAT HOME). • THERE MUST BE CLEAR EVIDENCE OF SIGNIFICANT IMPAIRMENT IN SOCIAL, SCHOOL, OR WORK FUNCTIONING. • THE SYMPTOMS DO NOT HAPPEN ONLY DURING THE COURSE OF APERVASIVE DEVELOPMENTAL DISORDER, SCHIZOPHRENIA, OR OTHER PSYCHOTIC DISORDER. THE SYMPTOMSARE NOT BETTER ACCOUNTED FOR BYANOTHER MENTALDISORDER (E.G. MOOD DISORDER, ANXIETY DISORDER, DISSOCIATIVE DISORDER, ORA PERSONALITY DISORDER). SOME OFTHE CHALLENGES WITH THE DSM – IV TR FORADHD • DEVELOPMENTALLY INSENSITIVE • CATEGORICALVIEW OF DISORDER • 6 MONTHS MAY BE TOO BRIEFFOR YOUNGER CHILDREN • 2 SETTINGS – MAY BE CHALLENGING TO GET EVIDENCE ACROSS SETTINGS OTHER CHARACTERISTICS • CO-OCCURRING DIAGNOSES ◦ 80% OF CHILDREN WITHADHD ◦ ODD PSY 325 L4 NOTES ◦ CD (30-50%, WASCHBAUSCH, 2002) ◦ ANXIETY (25%, MANASSIS, 2007) (ADHD SEEM TO HAVE LESS ISSUES WITH INATTENTION) ◦ MOOD (20-30%, SPENCER, 2000) UNDERSTANDING CHILDHOOD DISORDERS FRONTALLOBE (PREFRONTALCORTEXT- CONTROLS EXECUTIVE FUNCTONS) ADHD – BIOLOGICAL FACTORS ADHD RUNS IN FAMILIES • 1/3RD OF BIOLOGICAL RELATIVES ALSO HAVE ADHD (SMALLEY ETAL., 2000) • 3X HIGHER IN BIOLOGICALTHAN ADOPTIVE PARENTS OF CHILDREN WITHADHD • GENES INVOLVED – THOSE THAT REGULATE DOPAMINE ◦ REWARD SEEKINGAND SENSORY MOTOR ◦ DOPAMINE RICH AREAS OFTHE BRAINARE IMPACTED BYADHD ◦ MEDICATION WORKS ON THE DOPAMINE SYSTEM (ALLOWING THERE TO BE MOREAT THE SYNAPSE) (DAT1 RECEPTOR). ◦ DOPAMINE MAY BE RELATED TO THE BEHAVIOURAL SYMPTOMS OF ADHD PSYCHOLOGICAL FACTORS EXECUTIVE FUNCTIONS - KEYAREAOFDEFICIT 1. ORGANIZE, PRIORITIZE, ANDACTIVATE 2. FOCUS, SHIFTAND SUSTAINATTENTION PSY 325 L4 NOTES 3. REGULATE ALERTNESS, EFFORTAND PROCESSING SPEED 4. MANAGE FRUSTRATIONAND MODULATE EMOTIONS 5. WORKING MEMORY – KEEPING INFORMATION IN MIND WHILE COMPLETINGANOTHER TASK 6. SELF-MONITORING 7. LEARNING DISABILITIES 8. ACADEMICACHIEVEMENT CHALLENGES 9. DISTORTED SELF-PERCEPTION – POSITIVE ILLUSORY BIAS (PERCEPTION OF HOW GOOD YOUARE AT SOMETHING VS HOW GOOD THEY REALLY DO)(OWENS ETAL., 2007) SOCIALFACTORS • RELATIONSHIPCHALLENGES ◦ FAMILY ◦ PEERS • CULTURE AND GENDER ADHDAND GENDER DIFFERENCES PREVALENCE • 2-4% -GIRLS • 4-9% - BOYS • GENDER EXPECTATIONS MAY IMPACT ON RATES OF REFERRAL (SILVERTHORN ETAL., 1996) • DSM-IV-TR CRITERIA • GIRLS – INATTENTIVE, ANXIETY, DEPRESSION • BOYS – HYPERACTIVE, AGGRESSIVE,ANDANTISOCIAL(RUCLIDGE & TANNOCK, 2001) ◦ COMMUNITY SAMPLE VS. CLINIC SAMPLE PSY 325 L4 NOTES ◦ INCREASED RISK FOR SPECIFIC DISORDERS BASED ON GENDER TREATMENT MEDICATION • PARENT MANAGEMENT TRAINING • INTENSIVE INTERVENTION – MULTI-MODELTREATMENT STUDY • FOR CHILDREN (MTA) • INDIVIDUALCOUNSELLING • FAMILY COUNSELLING TREATMENT MEDICATION • MOST STUDIEDAND MOST EFFECTIVE MANAGEMENT OFADHD SYMPTOMS (SPENCER ETAL., 2000) • DEXTR
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