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Chapter 14 Practice Exam Questions

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Konstantine Zakzanis

Chapter 14: Disorders of Childhood LEARNING GOALS 1. Be able to describe the issues with the classification of psychopathology in children. 2. Be able to discuss the description, etiology, and treatments for externalizing problems, includingADHD and Conduct Disorder, and for internalizing problems, including depression and anxiety. 3. Be able to distinguish between the distinctions between the different Learning Disabilities, as well as our current understanding of the causes and treatments for dyslexia. 4. Be able to describe the different systems for classifying mental retardation and the current research on causes and treatments. 5. Be able to describe the symptoms, causes, and treatments forAutism andAspergers syndrome. Summary Clinical Descriptions  Childhood disorders are often organized into two domains: externalizing disorders and internalizing disorders. Externalizing disorders are characterized by such behaviors as aggressiveness, noncompliance, overactivity, and impulsiveness; they include attention-deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder. Internalizing disorders are characterized by such behaviors as depression, social withdrawal, and anxiety and include childhood anxiety and mood disorders.  Attention-deficit/hyperactivity disorder (ADHD) is a persistent pattern of inattention,hyperactivity, and impulsivity that is more frequent and more severe than what is typically observed in children of a given age. Conduct disorder is sometimes a precursor to antisocial personality disorder in adulthood, though many children carrying the diagnosis do not progress to that extreme. It is characterized by high and widespread levels of aggression, lying, theft, vandalism, cruelty to other people and to animals, and other acts that violate laws and social norms.  Mood and anxiety disorders in children share similarities with the adult forms of these disorders. However, differences that reflect different stages of development are also important.  Learning disorders are diagnosed when a child fails to develop to the degree expected for his or her intellectual level in a specific academic, verbal, or motor- skill area. These disorders are often identified and treated within the school system rather than through mental health clinics.  The DSM-IV-TR diagnostic criteria for mental retardation are subaverage intellectual functioning and deficits in adaptive behavior, with onset before the age of eighteen. Most professionals, however, focus more on the strengths of individuals with mental retardation than on their assignment to a particular level of severity. This shift in emphasis is associated with increased efforts to design psychological and educational interventions that make the most of individuals’ abilities.  Autistic disorder, one of the pervasive developmental disorders, begins before the age of two and a half. The major symptoms are a failure to relate to other people, communication problems, consisting of either a failure to learn any language or speech irregularities, such as echolalia and pronoun reversal, and theory of mind problems. Etiology  There is strong evidence for genetic and neurobiological factors in the etiology of ADHD. Low birth weight and maternal smoking are also risk factors. Family factors interact with these genetic vulnerabilities.  Among the apparent etiological and risk factors for Conduct Disorder are a genetic predisposition, inadequate learning of moral awareness, modeling and direct reinforcement of antisocial behavior, negative peer influences, and living in impoverished and crime-ridden areas.  Etiological factors for mood and anxiety disorders in children are believed to be the same as in adulthood, though additional research is needed.  There is mounting evidence that the most widely studied of the learning disorders, dyslexia, has genetic and other neurobiological components.  The more severe forms of mental retardation have a neurological basis, such as the chromosomal trisomy that causes Down syndrome. Certain infectious diseases in the pregnant mother, such as HIV, rubella, and syphilis, as well as illnesses that affect the child directly, such as encephalitis, can stunt cognitive and social development. Malnutrition, severe falls, and automobile accidents that injure the brain can also have negative effects on development. Environmental factors are considered the principal causes of milder mental retardation.  Family and twin studies give compelling evidence of a genetic predisposition. Abnormalities have been found in the brains of autistic children, including an overgrowth of the brain by age 2 and abnormalities in the cerebellum. Treatment  Acombined treatment including stimulant drugs, such as Ritalin and reinforcement for staying on task, has shown effectiveness in reducing the symptoms ofADHD.  The most promising approach to treating young people with conduct disorder involves intensive intervention in multiple systems, including the family, school, and peer systems.  The most effective interventions for mood and anxiety disorders are cognitive- behavioral therapy. Medication is effective for depression among adolescents, though its use is not without controversy.  The most widespread interventions for dyslexia are educational.  Many children with mental retardation who would formerly have been institutionalized are now being educated in the public schools under the provisions of Public Law 94-142. In addition, using applied behavioral analysis, self-instructional training, and modeling, behavior therapists have been able to treat successfully many of the behavioral problems of individuals with mental retardation and improve their intellectual functioning.  The most promising treatments for autism are psychological in nature, involving intensive behavioral interventions and work with parents. Various drug treatments have been used but have proven less effective than behavioral interventions. 1. Abnormal behavior in children a. is based upon destructiveness at any given age. b. is developmentally determined; that is, normal behavior at one age is abnormal at another. c. can be reliably determined across age groups. d. is typically associated with a lack of control. Answer: B Type: Factual Page: 450 2. You witness a child in the grocery store kicking and screaming because his mother won't buy him candy. Which of the following DSM-IV disorders would apply to the child? a. conduct disorder b. oppositional defiant disorder c. It depends on the mother’s response; if she gives in, the behavior is probably not a disorder, but the result of poor parenting strategies. d. There is not enough information provided to make a diagnosis. In addition, it depends on the child's age. Answer: D Type:Applied Page: 450 3. When diagnosing a child, it is most important to consider the child’s a. intelligence. b. ethnicity. c. gender. d. age. Answer: D Type: Factual Page: 450 4. Externalizing problems are more frequent in _____, and internalizing problems are more frequent in ______, regardless of culture. a. boys; girls b. girls; boys c. boys; boys d. Gender distribution varies widely in different cultures. Answer:AType: Factual Page: 451 5. Results from a recent follow-up study of behavior problems in Thai and U.S. cultures suggest that a. U.S. children are referred to clinics more often for internalizing problems than externalizing problems. b. Thai children exhibit more externalizing behaviors. c. internalizing and externalizing behaviors are fairly comparable across cultures, but specific behaviors within these domains are not. d. behaviors should not be separated into internalizing and externalizing behaviors because a behavior that is viewed in one culture as internalizing may not be viewed the same way in a different culture. Answer: C Type: Factual Page: 452: Focus on Discovery 14.1 6. As compared to developmentally normal levels of hyperactivity, diagnosable hyperactivity a. impairs the child’s functioning. b. negatively affects the child’s ability to mature appropriately. c. is treatable only with medication. d. All of the above are true. Answer:AType: Factual Page: 451-452 7. Which of the following distinguishes children withADHD from other children? a. extreme distractibility. b. anxiety. c. problems only in classroom. d. poor social understanding. Answer:AType: Factual Page: 453 8. Both attention-deficit hyperactivity disorder and conduct disorder are a. new to DSM-IV. b. even more of a problem to the individual child than to people who interact with him or her. c. internalizing disorders. d. externalizing disorders. Answer: D Type: Factual Page: 453 9. Children labeled "hyperactive" would be usually diagnosed as having _________________ in DSM-IV. a. conduct disorder b. attention-deficit/hyperactivity disorder c. oppositional defiant disorder d. pervasive developmental disorder Answer: B Type: Factual Page: 453 10. Attention deficit hyperactivity disorder is characterized by all of the following except a. poor academic work. b. shyness. c. difficulty getting along with peers. d. distractibility. Answer: B Type:Applied Page: 453 11. The difference between attention-deficit hyperactivity disorder (ADHD) and simply being a "rambunctious kid" is that ADHD children a. demonstrate extreme behaviors for a given developmental period. b. have subtle brain damage. c. also have academic problems. d. are truant. Answer:AType:Applied Page: 451 12. Children with attention-deficit/hyperactivity disorder (ADHD) a. act socially inappropriate to gain attention from authority figures. b. have no conception of what socially appropriate behavior is within a certain context. c. know what socially appropriate behavior is, but choose not to act in that way. d. know what socially appropriate behavior is, but are often unable to act in that way. Answer: D Type: Factual Page: 451-453 13. Research on subtypes of attention-deficit/hyperactivity disorder indicates that those with both attentional and hyperactive problems a. have equivalent outcomes to those with only attentional problems. b. are more likely to be placed in special education classes than children with only attentional problems. c. usually learn better than children with only attentional problems. d. are more likely to have a behavioral, rather than a neurological, basis for their problems. Answer: B Type:Applied Page: 453 14. The worst prognosis is for those children who have a. onlyADHD. b. only conduct disorder. c. bothADHD and conduct disorder. d. ADHD Predominantly Inattentive-type. Answer: C Type: Factual Page: 453 15. Aproblem facingADHD researchers is that a. reliance on small sample sizes asADHD is quite rare. b. definitions ofADHD are variable across studies. c. the follow-up periods are too short. d. ADHD children often will not comply with research activities. Answer: B Type: Applied Page: 454 16. Epidemiological studies indicate thatADHD a. is about equally common in boys and girls. b. is more common in boys. c. is more common in girls. d. is more common in girls with conduct disorder but in boys with oppositional defiant disorder. Answer: B Type: Factual Page: 454 17. Girls withADHD a. are more likely to be depressed than girls withoutADHD. b. show deficits in planning and problem-solving. c. are more likely to be adopted than girls withoutADHD. d. All of the above choices are correct. Answer: D Type: Factual Page: 454 18. When children with ADHD reach adolescence, a. their ADHD symptoms typically remit. b. other psychiatric disturbances are more prominent than theADHD. c. the severity of symptoms may be reduced, but they continue to meet criteria for the disorder. d. their academic performance greatly improves. Answer: C Type: Factual Page: 454 19. Studies of the persistence of ADHD into adulthood indicate that a. adults who were diagnosed withADHD as children are less likely to marry. b. adults who were diagnosed withADHD as children usually completely outgrow their symptoms. c. the rates ofADHD vary considerably depending on the assessment method employed. d. the rates of ADHD appear to increase in adulthood because so many adults seek out diagnosis in order to obtain prescriptions for stimulants like Ritalin. Answer: C Type: Factual Page: 454-455 20. What is the prognosis for most children withADHD? a. symptoms disappear by adolescence. b. adjust as adults despite minor problems. c. develop other psychological problems. d. little change in ADHD symptoms. Answer: B Type: Factual Page: 454-455 21. Eight-year-old Hank is extremely active and very distractible. He has particular difficulty in school, as he does not comply with the teacher's directions and has a hard time concentrating. When Hank reaches adolescence, he will most likely a. be in jail or juvenile hall. b. exhibit the same behaviors that he exhibits now. c. be less active but continue to have difficulty in school. d. outgrow his problem. Answer: B Type:Applied Page: 454-455 22. In recent molecular genetic studies, genes associated with the neurotransmitter_______________ have been linked toADHD. a. dopamine b. serotonin c. norepinephrine d. GABA Answer:AType: Factual Page: 455 23. Which of the following statements are true? a. Heritability estimates for ADHD are quite low. b. Asingle gene, such as the dopamine receptor gene DRD4, is most likely responsible for ADHD. c. Serotonin has been found to be associated withADHD etiology. d. Several genes interacting with various environmental factors most likely explain the cause ofADHD. Answer: D Type: Factual Page: 455 24. The genetic factors that are inherited by children withADHD are a. brain function and structure. b. neurotransmitter function and specificity. c. appetitive and metabolic functions. d. All of the above are correct. Answer:AType: Factual Page: 456 25. The hypothesis that ADHD has a genetic basis a. has been proven false; the disorder is more likely caused by environmental stress. b. has been demonstrated in twin studies. c. has been found to be true only for those children whose parents are also antisocial. d. has been found to be true only for those children who also have learning disabilities. Answer: B Type: Factual Page: 455 26. Although low birth weight is a predictor of the development ofADHD, _________ has been shown to help reduce the impact of low birth weight on later symptoms of ADHD. a. vitamin C b. maternal warmth c. nicotine d. breast-feeding Answer: B Type: Factual Page: 456 27. Investigations of the causes ofADHD have found that environmental toxins, such as food additives and lead a. do not explain more than a small percentage of cases. b. are usually the cause of the disorder in those children with an organic basis to their ADHD. c. are more likely to cause attentional problems without hyperactivity, but not in those children with both attentional problems and hyperactivity. d. cause subtle attentional problems, but not to the degree ofADHD. Answer:AType: Factual Page: 456 28. The association between nicotine andADHD is that a. children's smoking can cause attention problems. b. maternal smoking can cause hyperactivity in offspring. c. nicotine in pill form reduces the side effects of Ritalin. d. the combination of Ritalin and nicotine has been shown to cause dangerous synergistic effects in adults with ADHD. Answer: B Type:Applied Page: 456 29. Animal studies suggest that chronic exposure to nicotine can affect the developing fetus via the a. frontal lobes. b. serotonergic system. c. dopaminergic system. d. nervous system. Answer: C Type: Factual Page: 456 30. The relationship between maternal smoking andADHD is a. correlational. b. causal. c. dependent on the type of cigarette the women smokes. d. not well studied. Answer:AType: B Type: Factual Page: 456 31. Which best explains the fact thatADHD children and their parents typically struggle with discipline and obeying rules? a. ADHD children are often noncompliant and negative in interactions with their parents. b. Parents ofADHD children are demanding and disapproving. c. Most parents ofADHD children also haveADHD and are therefore are also noncompliant and negative. d. ADHD children do not understand verbal instructions. Answer:AType:Applied Page: 457 32. Stimulant drugs have which of the following effects on hyperactive children? a. increased activity level b. immediate and steady improvement in academic achievement c. short-term improvements in attention, goal-directed activity and behavior d. addiction to the medication Answer: C Type: Factual Page: 457 33. Ritalin a. has not been shown to be effective for improving long-term academic achievement. b. has been shown to have equal effectiveness to behavioral training alone. c. has been shown to be more effective in white children than Latino orAfricanAmerican children. d. All of the above choices are correct. Answer:AType: Factual Page: 457 34. Medications for children withADHD have little effect on their a. classroom misbehavior. b. social interactions. c. academic achievement. d. concentration. Answer: C Type: Factual Page: 458 35. Studies of intensive behavioral treatment in managingADHD show that behavioral treatment a. more effectively controlled disruptive behavior than Ritalin. b. alone was as effective as Ritalin. c. was completely ineffective. d. allowed for lower dosages of Ritalin in reducingADHD symptoms. Answer: D Type: Factual Page: 457 36. Rafael is a constant source of problems for his third grade teacher, as he is out of his seat every time she turns around, talking to other children, looking to see what is on their desks or outside the window, or simply walking up to the front of the classroom to converse with the teacher. Which of the following interventions would probably be most effective in improving Rafael's school behavior? a. operant conditioning involving a token reward system. b. anti-anxiety medication. c. long term psychodynamic treatment. d. cognitive-behavior therapy aimed at reducing impulsivity. Answer:AType:Applied Page: 458 37. One of the most difficult diagnostic issues for mental health professionals treating children today is a. distinguishing between learning disabilities and mental retardation. b. distinguishing between bipolar disorder andADHD. c. coming to a consensus on externalizing behaviors and internalizing behaviors. d. distinguishing between autism and Rett’s disorder. Answer: B Type: Factual Page: 459: Focus on Discovery 14.2 38. The use of stimulant medications in children and adolescents a. leads to dramatic increases in illicit drug use. b. leads to later alcohol abuse. c. does not lead to increases in illicit drug use with the exception of cocaine. d. has decreased in recent years. Answer: C Type: Factual Page: 459: Focus on Discovery 14.2 39. Which of the following is the best reason for the dramatic increase in cases of autism in the past decade? a. There are more carcinogenic materials in the environment today than ever before. b. More children are in full-time daycare than ten years ago. c. There is greater public awareness of autism. d. More frequent administration of the MMR vaccine. Answer: C Type: Factual Page: 459: Focus on Discovery 14.2 40. Shannon, a junior in high school, was recently suspended from school for stealing money from ninth-graders, writing graffiti on the bathroom walls, and beating up another student. Shannon's teacher reports that she has very few friends. The most likely diagnosis for Shannon would be a. attention-deficit/hyperactivity disorder. b. antisocial personality disorder. c. oppositional defiant disorder. d. conduct disorder. Answer: D Type:Applied Page: 461 41. Which of the following is not a symptom of oppositional-defiant disorder? a. extreme physical aggressiveness b. temper tantrums c. refusing to follow directions d. annoying others deliberately Answer:AType: Factual Page: 461 42. The difference between "conduct disorder" and "oppositional defiant disorder" is a. still a matter of debate. b. devious, sneaky, behaviors associated with conduct disorder. c. the onset of conduct disorder is earlier. d. conduct disorder is often comorbid withADHD, while oppositional defiant disorder is not. Answer:AType: Factual Page: 461 43. Compared to children withADHD, children with oppositional defiant disorder a. are more impulsive. b. are more planful. c. are more likely to be male. d. have more attentional deficits. Answer: B Type: Factual Page: 461 44. Conduct disorder is associated with a. substance abuse. b. ADHD. c. depression. d. All of the above are associated with conduct disorder. Answer: D Type: Factual Page: 461-462 45. Frank was just diagnosed with conduct disorder. He recently stormed into an electronics store, beat up the clerk, and stole a video game system. He also lit a neighbor’s cat on fire and sprayed graffiti on a local church. At what age did Frank most likely commit these crimes? a. 9 b. 17 c. 28 d. None of the above; it is not possible to guess. Answer: B Type:Applied Page: 462 46. Conduct disorder in childhood is most likely to lead to which adult disorder? a. schizophrenia. b. sadistic personality disorder. c. antisocial personality disorder. d. paranoid personality disorder. Answer: C Type: Factual Page: 462 47. Sam is a 16-year-old adolescent who feels that he is unable to be an adult, despite the fact that he’s nearly 6 feet, 3 inches tall and has grown a beard.Although he led a “normal” childhood, when he was about 11, he began to get into frequent fights at school and has had trouble with the law ten times. According to Moffitt, Sam would be categorized as having a. life-course persistent conduct problems. b. adolescence-limited conduct problems. c. antisocial development disorder. d. explosive personality disorder. Answer: B Type:Applied Page: 462 48. Based on the results from Moffitt’s longitudinal study, if Sam (from the previous question) is assessed during early adulthood, which of the following is the most likely outcome for him? a. Sam will report feeling depressed but will exhibit no antisocial behavior. b. Sam continues to show some conduct problems, but reports that he is beginning to “grow out of it.” c. Sam continues to commit crimes and abuse drugs. d. Sam has been diagnosed with oppositional defiant disorder. Answer: C Type:Applied Page: 462 49. Moffitt has theorized two forms of conduct disorder distinguished by their different a. response to treatment. b. seriousness of symptoms. c. hormone levels. d. prognoses. Answer: D Type: Factual Page: 462 50. Both ______________ and ______________ theories of the etiology of conduct disorder have empirical support. a. genetic; environmental b. behavioral; psychoanalytic c. biochemical; behavioral d. labeling; biological Answer:AType: Factual Page: 463-464 51. Research on the role of genetics in conduct disorder has found that a. conduct disorder is primarily genetically determined. b. the different behaviors of conduct disorder reflect differential genetic influence. c. the concordance rates of MZ twins are not appreciably different from DZ twins. d. biological factors play a more prominent role in late-onset antisocial behavior than early-onset antisocial behavior. Answer: B Type: Factual Page: 463 52. Which of the following factors were found to be predictive of conduct disorder in a large scale research study on children from New Zealand? a. being maltreated as children and low birth weight b. presence of low MAOAactivity c. low birth weight and being male d. both maltreatment and low MAOAactivity Answer: D Type: Factual Page: 464 53. Neuropsychological findings from research on conduct disorder children suggests impairment in all of the following areas except a. memory. b. problem-solving. c. focused attention. d. verbal skills. Answer: C Type: Factual Page: 464 54. According to learning theorists, aggressive behavior is a. both modeled and rewarded in society. b. is modeled, but not rewarded in society. c. is not modeled, but is rewarded in society. d. is neither modeled, nor rewarded in society. Answer:AType: Factual Page: 464 55. Children with conduct disorder a. feel badly for their wrong-doings, but cannot help themselves. b. have moral awareness, but choose not to abide by it. c. often feel guilty for their wrong-doings. d. lack moral awareness and remorse for their wrong-doings. Answer: D Type: Factual Page: 464 56. According to Dodge and Frame (1982), aggressive children demonstrate cognitive biases in situations a. in which peers act aggressively. b. in which peers act in a prosocial manner. c. which are ambiguous. d. in which they are rejected. Answer: C Type: Factual Page: 27 57. Conduct disorder is more common in children whose parents are a. harsh and inconsistent disciplinarians. b. psychologically disordered. c. overprotective. d. ethnic minorities. Answer:AType: Factual Page: 464 58. Which of the following has not been investigated regarding peers and antisocial behavior? a. Competitiveness with peers. b. Acceptance by peers. c. Rejection by peers. d. Affiliation with deviant peers. Answer:AType: Factual Page: 465 59. Sociocultural perspectives on conduct disorder suggest a. disadvantaged children are very likely to become antisocial. b. disordered thinking is a result of exposure to antisocial acts among disadvantaged groups. c. early antisocial behavior in combination with socioeconomic disadvantage leads to conduct problems. d. there are established ethnic differences in antisocial behavior. Answer: C Type:Applied Page: 465 60. Which of the following has been shown to be a promising treatment for conduct disorders? a. medication b. covert desensitization c. parent-management training d. juvenile justice programs Answer: C Type: Factual Page: 465-466 61. In the treatment of conduct disorder, the most promising approaches focus on the a. individual. b. family. c. school. d. legal system. Answer: B Type: Factual Page: 465-466 62. Head Start a. improves intellectual functioning of the neediest children to a level akin to their peers. b. uses medical and psychological interventions only. c. is targeted towards children with developing conduct disorder andADHD. d. None of the above are correct. Answer: D Type: Factual Page: 466: Focus on Discovery 14.3 63. Relative to other disadvantaged children who attended a different pre-school or no preschool, Head Start children a. had significantly improved social-cognitive abilities and motor impulsivity. b. had significantly higher overall IQ’s. c. were less socially proactive. d. had similar impulsivity problems. Answer:AType: Factual Page: 466: Focus on Discovery 14.3 64. Multisystemic therapy a. focuses solely on the conduct disordered child. b. is based upon intervention in ecologically valid settings such as home, school or peer group. c. is a combination of medication and individual therapy. d. is multifaceted in the sense that multiple approaches to family intervention are applied. Answer: B Type: Factual Page: 467 65. Sixteen-year-old Chris had a history of trouble with the law since age 10; most recently, he was picked up by the police because he was truant from school and was vandalizing a bus stop with several friends. He was court-ordered to Dr. Henggeler's program for multisystemic treatment. Which of the following was probably a part of the treatment? a. medication to reduce Chris’impulsivity b. separating Chris from the damaging effects of his current peer system c. conducting therapy at Chris' home or school d. All of the above choices are correct. Answer: C Type:Applied Page: 467 66. Brian was enrolled in a program of anger-control training to reduce his aggression.As part of his training, peers were told to insult Brian and he was told to a. respond with calm statements to the children, such as "I'm not going to let you upset me." b. firmly but politely tell them to stop. c. distract himself by humming or turning away. d. signal an adult when he begins to become angry. Answer: C Type:Applied Page: 468 67. Ten-year-old Sharita has appeared sad and tearful much of the time over the past three weeks. She shows little interest in playing the games she used to enjoy, rarely feels like eating, frequently complains of stomachaches, and lies awake at night, unable to fall asleep. Which of the following DSM-IV diagnoses would best fit Sharita? a. dysthymic disorder b. major depression c. separation anxiety disorder d. depressive reaction of childhood Answer: B Type:Applied Page: 469 68. Depressed children and depressed adults both exhibit which of the following symptoms? a. suicide attempts and guilt b. fatigue and suicidal ideation c. loss of appetite and early morning depression d. delusions Answer: B Type:Applied Page: 468-469 69. Adults with depression are more likely to have which of the following symptoms when compared to children? a. suicide attempts and guilt b. fatigue and suicidal ideation c. loss of appetite and early morning depression d. delusions Answer: C Type
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