When we talk about Neurodevelopmental Disorders (ex. ADHD, Autism), we denote
“developmental” to mean that it occurs and is diagnosed during a developmental period (aka
while you’re living with your parents such as infancy and up). It’s not necessarily “disorders of
childhood”. “Neuro” denotes that there is a presumed neurological basis (not for sure though, but
Neurodevelopmental disorders commonly co-occur (ex. ASD and ID often go together, ADHD
and specific learning disorder).
Something to keep in mind: Assessing and diagnosing children requires a lot of experience (in
fact, psychopathology in children is its own area of expertise). The reason for this is because kids
(independent of everyone else) are very complex as they are still developing psychologically and
so we need to be careful about what to consider clinically relevant (Kids do a lot of weird things
for a reason that may not be indicative of a disorder ex. her chicken nugget story). Another
reason is because we need to compare what the kids are presenting to what is developmentally
See DSM (slides 10-12) Notes: ADHD can be diagnosed in adults as long as it
started/happened in childhood. If it only started/happened in adulthood then it’s “other specified
attention disorder”. ADHD is sometimes over-diagnosed. For it to be properly diagnosed it
must actually be interfering with functioning (see criteria D). Ex: My kids performance in school
doesn’t match his IQ (due to the ADHD). Informant reports are used to see if these
symptoms are present in more than one setting (see criteria C).
Note that ADHD is a disorder about regulating attention (directing attention to something
important) NOT about an inability to focus.
Notes on specifiers: Combined is 50-75% of people, Predominantly inattentive is 20-30% (and
this one specifically is more common in girls), Predominantly hyperactive is 15%.
Prevalence is 5-6% in children, 2-3% in adults. Sex ratio is more male (estimates between 2:1
and 4:1). Very low birth rate is a risk factor as well as being exposed to toxins in utero or right
after birth (but we don’t know if this is a causality). These stats are common across cultures.
Associated Features: Mood lability/irritability, low frustration tolerance. In early adulthood there
is an elevated suicide attempt risk (especially if comorbid with mood, substance disorders).
Course is often stable through adolescence (some have declining course associated with
development of antisocial behaviour). Most often identified in early school years. Hyperactivity
symptoms often most noticeable in preschool age (adolescence and later: motor hyperactivity
more likely to be replaced by feelings of restlessness/impatience, fidgetiness. As well, with age
the inattention features become more prominent).
Functional consequences of ADHD: Reduced academic performance, reduced occupational
performance, interpersonal conflict, rates of unemployment due to looking for job options with
flexible deadlines which are not common jobs, higher rates of conduct disorder, antisocial PD, substance use disorders, incarceration rates (these higher rates more so in boys), rates of injury,
traffic violations and accidents. URRICI
Other functional consequences: Others may interpret lack of focus/attention to detail as reflecting
laziness or lack of care, higher rates of teasing and bullying (due to the hyperactivity symptoms)
as well as peer rejection/neglect (due to the inattention), Can affect self-esteem and social skills
Treatment: Drug treatment using stimulants such as Methylphenidate and Ritalin (side note: the
use of stimulants for ADHD was an accident since it was originally used for headaches but they
notice patients were calmer). It seems paradoxical to use stimulants but when combined with
behaviour interventions it has good efficacy (70% of treated children get reduction in symptoms
in that they now have increased attention and/or reduced disruptive behaviour. They see
improvements in academic performance and social connections).
The cons of this drug treatment: May increase risk of later substance use issues, we’re unsure
about the long-term effects of drug therapy, there’s a lot of over-prescription if these drugs, side
effects such as low appetite and sleep issues. Lastly, some kids don’t respond specifically in
terms of gains in academic functioning.
Psychosocial options: Usually involves doing CBT on parents to train them. First educate them
about ADHD. Then, increase positive acknowledgement (teach them to not criticize the child) of
child’s behaviours and implement reward-based systems. Learn to communicate
requests/expectations clearly and help the child meet them. Implement costs for minor rule
violations, time outs for majors.
Controlled acts are specific actions performed by someone in the process of administrating
health care. They are identified and outlined in the Regulated Health Professionals Act (ex.
what they are and who specifically can perform them – clinical psychologist can diagnose and
Controlled acts include: diagnosing people, administering psychotherapy (talk therapy),
prescribing medications, performing invasive procedures.
(note: I think the way it works is this: You have the Regulated Health Professionals Act which
outlines the controlled acts but then each regulated health profession has its own individual act
with more details of the job generally termed as “[health profession] Act” as well as its own
Nursing is a regulated health profession (Nursing Act and College Nurses Ontario). Ontario
nurses can, under appropriate circumstances for example: “Administer a substance by injection
or inhalation”, “Put an instrument, hand or finger beyond the opening of the urethra (catheter)”,
“Put an instrument, hand or finger into an artificial opening into the body”.
The professional regulatory body (aka College) resulting from an Act then develops registration
requirements (ex. what degrees needed, must be in good standing with the college, etc.) and standards of practice. For example: The Psychotherapy Act This established the College of
Registered Psychotherapists of Ontario (CRPO) (can’t diagnose, only talk therapy). To legally
call yourself a psychotherapist you must be registered in good standing with the CRPO.
Clinical psychologists are also regulated health professions. They are governed by the College of
Psychologists of Ontario (CPO). These colleges protect the public interest NOT the worker’s
protection; that is what a union is for. They protect public interest by keeping the professions
accountable for their competence and ensure ethical practice. Therefore, anything bad a
professional does (such as break a standard of practice) the college would be most concerned
with the safety of the public (not the worker).
CPO Standard of Practice
The standard of practice written by a college (ex. CPO) provides ethical guidelines for different
aspects of conduct with patients. Three examples of the CPO standard of practice:
1. Practicing within boundaries of one’s competence (this is a construct in health care).
a. The person must demonstrate that: They are authorized in the area of practice (ex.
forensic) and that they are authorized to deal with a certain client population (ex.
children, adolescents; a person can have multiple populations).
b. They require supervision until competence is established. If one wishes to expand
area of competence, they need to inform the college they’re interested in doing so.
The college will tell them to find a supervisor, study a certain