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Psychology 2320A/B
Erin Demaiter

Chapter One Textbook 01/30/2014 Chapter 1:Abnormal Child Psychology Children’s health problems differ in many ways from those of adults Georgina Looking at her to start an understanding of psychological disorders Age 10 Her behaviour became a concern when she was 8 and she started talking about harm to herself and her family: she would touch an arrange things a certain way, brush her teeth in a certain sequence, walk through doorways over and over Family doctor said it was just a phase Didn’t stop  everything had to be organized into groups (counting and grouping things while having conversations) Couldn’t go to bed until she finished counting things (sometimes took hours) She started failing classes Would her behaviour be viewed differently in a different country/culture? When seeking advice, research studies in child disorders seek to address Defining what constitutes normal and abnormal (for children of different ages, sexes, and ethnic backgrounds) Identifying the causes and correlates of abnormal behaviour Making predictions about long term outcomes Developing and evaluating methods for treatment and or prevention Sometimes children enter mental health system as a result of concerns from parents or teachers They also seem to be having issues developing properly Many problems shown by children and youths are not entirely abnormal so decisions about what to require familiarity with known disorders When dealing with children and their disorders it is more about PROMTING FURTHER DEVELOPMENT rather than just restoring previous levels of functioning (with adults they try to get rid of distress) Historical Views and Breakthroughs Valuing children as persons in their own right was not always a priority in society Sometimes they used to be viewed as servants of the state Greek and Roman societies believed that any person, young or old with a disability or handicap was an economic burden and embarrassment (they may have been abandoned or sentenced to death) Prior to 18 century, children’s disorders were not mentioned very much in the medical field The Church had a strong influence on children and their weird behaviours  when non religious people had things to say they were not given serious consideration because possession by the devil was the only explanation anyone needed Historically, 2/3 of kids would not make it to their fifth birthday Many children were subjected to harsh treatments by parents Aparent’s prerogative to enforce child obedience was formalized by the MASSACHUSETTS STUBBORN CHILDACT of 1654 (children were to be put to death if they misbehaved… fortunately no kids ever had this done to them)… in the 1800’s kids were allowed to be kept in cages and cellars The Emergence of Social Conscience We now know that before any real change occurs it requires a philosophy of humane understanding in how society recognizes and addresses the special needs of some of its members UN Convention of the Rights of the Child 1989…recognizes the rights of children John Locke: a main member of social conscience emerging …he believed in individual rights and he expressed novel an opinion that children should be raised with thought and care  he saw children as emotionally sensitive beings Jean Marc Itard: child was undertaken by him, for severe developmental delays rather than sending him to an asylum…this was a launch of a new era Leta Hollingworth: argued that many mentally defective children were actually suffering from emotional and behaviour problems because of treatment from adults THIS VIEW led to  important and basic distinction between persons with “MENTAL RETARDATION” and those with psychiatric or mental disorders “LUNATICS” “Moral Insanity”: in acceptance as a means of accounting for non intellectual forms of abnormal child behaviour Moral Insanity the only guidance they had previously had in distinguishing children with intellectual deficits from children with behavioural and emotional problems was derived from religious views of immoral behaviour children who had normal cognitive abilities but who were disturbed were thought to suffer from moral insanity (disturbed personality or character) kids were thought to not be capable of full adult like insanity the concern of children with these issues began to rise with two important influences Advances in general medicine, physiology and neurology were happening, so the view of moral insanity was being replaced by the organic disease model which had more humane forms of treatments to be considered (for example using human medicine to help kids who had previously been put in cellars) More people were influencing the theories which led to people thinking children needed moral guidance and support These two thoughts improved health practices Now people saw abnormal children as a result of biological, sociological, cultural and environmental factors Victor of Aveyron “wild boy” discovered by hunters when he was 11 or 12 lived in the woods alone all his life Jean Marc Itard, believed the boy was mentally arrested because of social and educational neglect He wanted to see if his retardation could be corrected He was dirty, non verbal, incapable of holding attention and insensitive to basic things such as hot and cold Itard used many things to bring about his sensations (hot baths, massages) After 5 years Victor had learned to identify objects and other things Victor never got to a “normal state” This was one of the first times an adult tried to get to know and help a child with these “conditions” The deep investment on the part of an individual child and their needs is a key aspect of helping orientation to this day Early BiologicalAttributions In earlier years people thought mental disabilities to be all biological The notion of masturbatory insanity illustrates how the prevailing political and social views of a society influence the definition of insane or “psychopathology” There was a general public ignorance and avoidance of issues involving people with mental disorders Clifford Beers tried to change the attitudes, he believed that mental disorders were a form of disease, he didn’t like society’s ignorance and indifference and wanted to prevent mental disease by raising the standards of care His view was based on a biological disease model and intervention was limited to persons with mostly visible disorders So again, society returned to the view that mental illness and retardation were disease that could spread if left unchecked **for the next two decades people chose to prevent the procreation of the insane through eugenics (sterilization) and segregation Masturbatory Insanity children masturbating was the first “disorder” unique to children they called it a form of mental illness and in keeping with the though that such problems resided within the individual, it was seen as a big problem for kids the medical view of masturbation focused initially on adverse effects on physical health the interest in this changed by the end of the 19 century eventually the notion of masturbatory insanity gave way to the concept of neurosis it was not until the 20 century that the belief in masturbation and insanity were not combined any longer **this is an important example of the scientific skepticism in confirming or not confirming new theories of abnormal behaviour Early PsychologicalAttributions biological influences must be balanced with developmental and cultural factors this perception was not always the case people always thought the problem were within the individual which led to neglecting the essential role of a person’s surroundings early 20 century, attention drawn to the importance of psychological disorders and to formulating a taxonomy of illnesses this recognition allowed researchers to organize and categorize ways of differentiating among different problems this prompted the development of diagnostic categories, expansions of deviant behaviour Two Major Paradigms: Helped Shape These Emerging Psychological and Environmental Influences Psychoanalytic  he believes that individuals have inborn drives and predispositions that affect their development He also thought that children could be helped and changed, which was a first (this was not thought before) Freud was the first to think that maybe their was link between mental disorders and childhood experiences He thought that personality and mental health outcomes had multiple roots Freuds daughter, anna, expanded his ideas the understanding children in particular by noting how symptoms were related more to developmental stages than were those of adults “NOSOLOGIES”  the efforts to classify psychiatric disorders into descriptive categories are essentially nondevelopemntal in their approaches so rather than attempting, like Freud does, to describe the development of the disease in the context of the development of the individual, nosologies such as the DSM model attempt to find common denominations that describe certain disorders Behaviorism The development of evidence based treatments for children, youths, and families can be traced to the rise of behaviorism as reflected in Pavlov’s experimental research the theory that human and animal behavior can be explained in terms of conditioning, without appeal to thoughts or feelings, and that psychological disorders are best treated by altering behavior patterns Watson, attempted to explain using terms like unconscious and transference using the language of conditioned emotional responses Families, communities and societal and cultural values play a strong role in determining how successful current child rearing ways are benefiting children LittleAlbert, Big Fears and Sex in Advertising LittleAlbert and his fear of white rats and other furry white objects Research done by John Watson Understanding the times and background of John Watson put these pioneering efforts intoa better perspective Watson was scared of the dark which caused him issues in adult life He used an 11 month old orphan baby named albert who was given a small white rat to touch, and he didn’t really mind it Then he would reach to touch the rat again and Watson would strike a steel bar with a hammer… this caused albert to not like the rat This conditioned him to fear the rabbit and they were able to make him scared of many different animals Evolving Forms of Treatment For a long time kids were institutionalized when they were thought that have issues Renee Spitz did research and raised serious questions about the harmful impact of institutions on children’s growth and development Being raised in institutions without adult physical contact and stimulation developed sever physical and emotional problems Between 1945 and 1965, there was a huge decline in the number of children in institutions and children in foster homes increased Behaviour therapy started to emerge…originally based on operant and classical conditioning Since then behaviour therapy has continued to expand in scope, and has emerged as a major form of therapy for a wide range of disorders Progressive Legislation Counties have advanced a lot in the treatment of children and youths which is evident in the various laws “Individuals with Disabilities Act”  free and appropriate education for any child with special needs…regardless of age they must be assessed with culturally appropriate tests, must have an individualized education program (IEP) Focus on understanding their rights and getting rid of physical, linguistic social and cultural barriers These efforts emphasize a shift in the attitudes and treatments towards people with disabilities “INDVIDUALS WITH HUMAN RIGHTS”  not just a “mentally retarded person” Box 1.4: UN Convention on the Rights of Persons with Disabilities 1. Parties should take all necessary measures to ensure the full enjoyment by children with disabilities of all human rights and fundamental freedoms on an equal basis of other children 2. Best interest of the children ALWAYS 3. Children with disabilities have the right to express their views freely on all matters affecting them What isAbnormal Behaviour in Children andAdolescents Lee Harvey Oswald  childhood behaviour was weird but when he was questioned by a police officer when he was 13 the complaint was about social isolation, school disinterest…this example shows how a relatively discrete problem can be difficult to classify into its causes HOW DO WE JUDGE WHAT IS NORMAL? WHEN DOES THE ISSUE BECOMEANACTUALY PROBLEM? WHYARE SOME CHILDREN’S PATTERNS OFWEIRD BHEAVIOUR RELATIVELY CONTINUOUS FROM EARLY CHILDHOOD THROUGHOUT THEIR ENTIRE LIVES WHILE OTHERS ARE MORE VARIABLE? Defining Psychological Disorders  whose standard of “normal” do we adopt “Psychological Disorder”  traditionally had been defined as a pattern of behavioural, cognitive, emotional, or physical symptoms shown by an individual  patterns can be associated with the following: distress, fear, sadness, behaviour shows some degree of disability, distress increases risk of physical harm Labels Describe Behaviour, Not People They do not describe people, only patterns of behaviour  “retarded child” or “autistic child” are not good to use…may be better to say “a child who has autism” “Stigma”  there is a stigma often regarded with mental health issues…it refers to a cluster of negative attitudes and beliefs that motivates fear, rejection, avoidance and discrimination Because of stigma, individuals with mental disorders may suffer from depression and hopelessness Differentiate between abnormal behaviour and disorder when talking about different children  the approach to defining abnormal behaviour is similar to one most often used to classify mental disorders… use the DSM model Competence  definitions of children and their abnormal behaviour must take into account the child’s COMPETENCE “Competence”  the ability to successfully adapt in the environment you are in For example, minority children have a lot of negative things to deal with Must consider not only the maladaptive behaviour the child shows, but also the extent to which they achieve normal developmental milestones “Developmental Tasks”  include broad domains of competence such as conduct, academic achievement, and they tell how typically a child progresses within each domain Age Period Task Infancy to Preschool -attachment to caregiver -language -differentiate self from environment -self control and compliance Middle Childhood -school adjustment -academic achievement -getting along with peers Adolescence -successful transition to high school -academic achievement -forming close friendships -cohesive sense of self identity Developmental Pathways  refers to the sequence and timing of particular behaviours and possible relationships between behaviours over time Multifinality one main issue had multiple effects suffer from maltreatment…some may have an eating disorder, some mood, some are fine just because we know that something happens, doesn’t mean that we can predict the exact outcome various outcomes stem from similar beginnings Equifinality variety of possible beginnings lead to one thing (bullying) could be genetic factors, but maybe not just genetics that lead to bullying family, environment, genetics, family may have all of those factors, doesn’t mean they will be a bully similar outcomes stem from different early experiences and developmental pathways Risk and Resilience  there are so many different developmental paths that can start in the same place “Risk” variables that precede a negative outcome and increase the chances that the outcome will occur not a one to one relationship personal or situational variables that reduce the chances of a child developing a disorder the more risk factors, the more likely you may have a disorder it is not one for one having one risk factor wont make you have a problem its more of an additive model (things adding together makes it worse) Child pregnancy and birth complications Family poverty, serious care giving deficits parental mental illness Protective Factors things that help protect Child high intellectual functioning Family authoritative parenting close relationship Community connection with adults interested in child’s welfare attending an effective school “Resilience” looking at the kids that have 4+ risks and thinking they are for sure going to have issues, but they didn’t the capability of individuals and systems to cope successfully in the face of significant adversity or risk this capability develops and changes over time and is enhanced by protective factors within the individual system and the environment and contributes to the maintenance or enhancement of health the protective triad helps to understand how we can prevent how can we do this protection there are something’s that you cannot reduce risk factors for if you cannot change genetics but how can you change the strengths of the child to help prevent any issues “protective triad”  strength in the child, strength of the family, strength of the school and community  the concept of resilience reminds us that a direct causal pathway rarely leads to a particular outcome Oprah was given a tough life…but she had enough resilience to work through it and look at her now!! Source Characteristics Individual -intellectual functioning -easygoing disposition -talents -faith -confidence Family -close relationship to parent or figure -authoritative parenting, warmth, high expectations -socioeconomic advantages -connections to extended family networks School and Community -adults outside the family who take interest in you -connections to school organizations -attendance to effective schools The Significance of Mental Health ProblemsAmong Children and Youths We now recognize that mental health problems of children and adolescents are frequently occurring “many if not most lifetime psychiatric disorders will first appear in early childhood” 1/8 has a mental health problem st By the 21 birthday, 3/5 young adults meet criteria for a well specified disorder (seems like a lot) The youngest ¼ of the generation have very few treatment options The demand for health care for mental disorders in children is said to double over the next decade The Changing Picture of Children’s Mental Health There is improved focus and detail have resulted in efforts to increase recognition and assessment of children’s disorders  in the past, children with these disorders and special needs were often described as “maladjusted” another difference is today young children and teens would appear more often in a picture of the global state of mental disorders  this reflects greater awareness of the unique mental issues  disorders such as depression and anxiety have increased as well (they used to be overlooked because the symptoms are often less visible) HOWEVER, what has not changed from the past is the proportion of children who are receiving proper services to help them Less than 10 percent of children get the proper health care for their disorders  it is beginning to change a little bit… more attention being paid to treatment programs **Mental health problems are unevenly distributed…the people disproportionately afflicted are: 1. children from disadvantaged families 2. children from abusive families 3. children without adequate child care 4. children born a low birth weight 5. children with parents of mental illness Poverty and Socioeconomic Disadvantage The background and circumstances of children with mental health problems provide OBVIOUS clues to the origins Childhood poverty is about 1/7 in Canada Poverty affects a child’s mental health  low income tied to many other forms of disadvantage (less education, low paying jobs, not very good health care) The impairments to children may have something to do with the pronounced effect on the prefrontal cortex development  the greater the degree of inequality, powerlessness, and lack of control, the more likely a child is to have a mental disorder Sex Differences Obviously, girls and boys express their emotions in different ways Boys: hyperactivity, autism, disruptive behaviour, and communication disorders Girls: anxiety, depression and eating disorders  We don’t understand, though, whether these differences are caused by definitions, reporting bias or differences in the expression of the disorder For example, fighting is more physical and direct in boys and indirect within girls “Internalizing Problems”  include anxiety depression, somatic complaints, and with drawn behaviour “Externalizing Problems”  more acting out behaviours, like aggression and bad behaviour *** figure in text  externalizing problems stat out higher in boys than for girls and that these problems decrease gradually for boys and girls until the rates are almost together by the age of 18 ***  it is the opposite for internalizing, they start out similar and then increase, with girls ending higher than boys  Resilience in boys is associated with households in which there is a male role model, and girls who display resilience come from households that combine risk taking and independence with support from a female caregiver Race and Ethnicity It is expected that the rate of minority people will be 62 percent by 2050 (it is 44 percent now) Thinking of race as a socially constructed concept helps to explain why very few emotional and behavioral disorders of childhood occur at different rates for different racial groups Minority children are over represented in rates of substance abuse, teen suicide and acting out BUT once the effects of SES, sex, age, and referral status are controlled form few differences in the rate of children’s disorders emerge in relation to race and ethnicity Minority children face multiple disadvantages, such as poverty and exclusion from society’s benefits referred to as “marginalization” Culture Achild’s ethnic background and cultural surroundings are all important contributors to the manner in which his or her behavioural problems are expressed and recognized by others ADHD may be viewed differently in other places and not even seen as a disorder Lifespan Implications Many childhood problems can have lifelong consequences About 20 percent of the children with the most chronic and serious disorders face sizable difficulty in their lives They are least likely to finish school and most likely to have social problems or psychiatric disorders that affect many parts of their lives The costs are enormous with respect to demands on community resources such as health, education, mental health and criminal justice systems Chapter Two Textbook 01/30/2014 Child and family disturbances result from multiple, interacting risk factors (cannot not account just one factor to the problem) Jorge (What is Causing Jorge’s Problems) 14 years old  referred to doctor for academic problem “too quiet and too nervous” Jorge said it was the teachers  they yell at him His parents had their own opinions  moved to a new neighborhood, sometimes the mom gets really mad at Jorge (yells), mom thinks he has a learning disability, they think he needs meds to calm him down  SO WHAT IS CAUSING THE PROBLEMS 1. Biological Influences  prenatal history anxiety can be paired with stress hormones not circulating properly in the body  include both genetic and neurobiological factors that are often established and by no means fixed at birth or pretty much right after 2. Emotional/Psychological Influences  show various emotional signals that are not always obvious at first he gets overwhelmed with homework…panics when he thinks about school not being able to regulate arousal emotional reactivity and expression are the ways kids first communicate  emotions, relationships and thought processes 3. Behavioral and Cognitive Influences a behavioural approach might be to try and change aspects of his environments such as the attention he receives from his teachers or parents for his gradual and slow efforts to do his homework maybe increasing the likelihood of reinforcement COGNITIVE  such as a person’s interpretation of events are also important…how does Jorge view the situation? 4. Family, Cultural and Ethnic Influences all children require a parenting style that is sensitive to their needs and abilities Chapter Two Textbook 01/30/2014 children need a basic quality of life that includes a safe community, good schools, good nutrition  family, social, and cultural influences which set additional parameters on normal and abnormal development Theoretical Foundations  defining what is abnormal within the context of children’s on going adaptation and development and sorting out the most probably causes of the problem is complicated Atheory allows us to make educated guesses and predictions about behaviour that are based on existing knowledge and it allows us to explore these possible explanations  an important theme to keep in mine is considering multiple, interactive causes for abnormal behaviour, in conjunction with the major developmental changes that normally occur “Multiply Determined”  abnormal child behaviour is multiple determined and we have to look beyond the child’s current symptoms and consider developmental pathways and interacting events 3 Underlying Themes 1. Multiply Determined 2. The child and the environment are interdependent (how the influence each other) 3. Abnormal development involves continuities and discontinuities of behaviour over time  The complexity of abnormal child behaviour requires consideration of the full range of biological, psychological and sociocultural factors that influence children’s development “Transaction”  how the child and environment interact Atransactional view regard both children and the environment asACTIVE CONTRIBUTERS  Continuity Developmental changes are gradual and quantitative They are predictive of future behaviour patterns Gradual changes in the same behaviour  Discontinuity Developmental changes are abrupt and qualitative Not predictive of future behaviour patterns Age in years arbitrarily segments continuous development Can think of autism this way Chapter Two Textbook 01/30/2014 Appear to be developing normally and the all of a sudden they just changed and regressed Or even eating disorders…onset in early and mid adolescence…normal eating patterns and no issues and then something happens and there is an abrupt change  ** there are atypical and typical changes for children that are normal at different times Developmental Considerations  even though children’s psychological disorders have very different symptoms and causes, they share common ground (they are an indication ofADAPTATIONAL FAILIRE IN ONE OR MOREAREAS OF DEVELOPMENT) “Adaptational Failure”  the failure to master or progress in accomplishing developmental milestones (keep in mind it is rarely to do with one factor) Children’s development is organized which means that early patterns of adaptation evolve over time and transform into higher order functions in a structured, predictable manner  developmental psychology emphasizes the importance of developmental processes and tasks Developmental psychopathology provides a useful framework for organizing the study of abnormal child psychology around milestones and sequences in physical, cognitive, socio emotional and educational development “Organization of Development”  in this perspective, early patterns of adaptation, such as infant eye contact and speech sounds evolve with structure over time and transform into higher order functions “Sensitive Periods”  windows of time during which environmental factors on development both GOOD AND BAD are enhanced  infants for example are highly sensitive to emotional cues and proximity to their caregiver **Simply Stated  a child’s current abilities or limitations are influenced by prior accomplishments, just as your progress through math depends on the command of math skills you had when you were in the younger grades “Developmental Cascades”  refer to the process by which a child’s previous interactions and experiences may spread across other systems and alter his or her course of development…kind of like a chain reaction **  can explain how processes that function at one level or domain of behaviour (like curiosity) can affect how the child adapts to other challenges later on (like school performance) Biological Perspectives Broadly speaking, this perspective considers brain and nervous system functions as underlying causes of psychological disorders in children and adults Chapter Two Textbook 01/30/2014 Brain functions undergo continual changes, described as neural plasticity, as they adapt to environmental demands  neural plasticity, or malleability means the brains anatomical differentiations is use dependent: nature provides the basic processes, where as nurture provides the experiences needed to select the most adaptive network of connections Genetic influences depend on the environment Genetic endowment influences behaviour, emotions, and thoughts Environmental events are necessary for this influence to be expressed Gene-Environment interactions (G X E) explain how the environment shapes our genotype through a process called epigenetics Neurobiological contributions to abnormal child behaviour include knowledge of brain structures, the endocrine system and neurotransmitters, all of which perform their functions in an integrated, harmonious fashion **Genes determine the main high ways along which axons travel to make their connection, but to reach particular target cells, axons follow chemical cues strewn along their path that tell them the direction Selective “pruning” reduces the number of connections in a way that gradually shapes and differentiates important brain functions “To what extent are given behaviours due to variations in genetic endowment, the environment and the interaction between these two factors?”  Genetic Contributions virtually any trait a child has results from the interaction of environment and genetic factors 22 matched pairs XY for males, XX for girls Some genetic influences are expressed early in development such as behavioural inhibition or shyness, but others show up later which emphasizes that genetic influences are malleable  a gene is basically a stretch of DNAand by itself it does not produce a behaviour or emotion  it produces a protein (THEY PRODUCE TENDENCIES TO RESPOND TO THE ENVIRONMENT IN CERTAIN WAYS) “Genes influence how we respond to the environment and vice versa” Gene Environment Interaction (G X E) Researchers refer to this interplay of nature and nurture as gene environment interaction The biological changes to genetic structure result from EPIGENETIC (changes in gene activity resulting from environmental factors) mechanisms Chapter Two Textbook 01/30/2014 G X E helps explain why some people have disorders and others do not, in the face of similar environmental events Epigenetic alterations may be reversible through pharmacological and behavioural interventions Behavioural Genetics  a branch of genetics that investigates possible connections between a genetics predispositions and observed behaviour, taking into account environmental and genetic influences  often times these researchers will conduct familial aggregation studies (non random clustering of disorders or characteristics in the general population) Molecular Genetics  offers more direct support for genetics  directly assesses the association between variations in DNAsequences and variations in particular traits Most forms of abnormal child behaviour are POLYGENETIC which means they involve a number of susceptibility genes that interact with one another and with the environment **specific genes are sometimes associated with certain forms of mental retardation but usually not just one specifically Neurobiological Contributions  must look at brain structures Structure and Function  brain is often divided into the BRAIN STEM and FOREBRAIN Brain Stem: the lowest part of the brain stem is called the hindbrain (contains the medulla, the pons and the cerebellum  it provides essential regulation of autonomic activities)  also contains the midbrain which is in charge of movement with sensory input  MIDBRAIN houses the reticular activating system (RAS) which contributes to processes with arousal and tension  at the very top of the brain stem is the diencephalon (contains the thalamus and the hypothalamus which are both essential to the regulation of behaviour and emotion) Forebrain: evolved in humans into highly specialized functions  at the base is an area called the limbic or border system (contains structures suspected causes to psychopathology  hippocampus, cingulate gyrus, septum, amygdala)  limbic system regulates the basic drives for sex, aggression, hunger and thirst  also at the base is the basal ganglia (including the caudate nucleus) Chapter Two Textbook 01/30/2014 The cerebral cortex: the largest part of the forebrain, and gives us our distinctly human qualities and allows us to look at the future and plan  LEFT HEMPISHERE = dominant right handed persons, plays a chief role in verbal and other cognitive process  RIGHT HEMPISHERE = dominant left handed persons, are better at social perception and creativity  researchers believe that each hemisphere plays a different role in certain psychological disorders The Lobes of the Brain and their Functions Frontal Lobes: controls the functions underlying most of our thinking and reasoning abilities  all of these functions mature well into late adolescence and early adulthood  self control, judgment, emotional regulation, restructured in teen years Parietal Loves: integrate auditory, visual and tactile signals, immature until age 16 Corpus Callosum: intelligence, consciousness, self awareness, reaches full maturity in 20s Temporal Lobes: emotional maturity, still developing after age 16 **these critical brain areas perform their functions in an integrated harmonious fashion The Endocrine System  linked to specific psychological disorders such as anxiety and mood disorders theADRENAL glands are most familiar because they produce EPINEPHERINE (in response to stress) Epinephrine energizes us and prepares our bodies for possible threats or challenges Thyroid Gland: produces the hormone THYROXINE which is needed for proper energy metabolism and growth and is implicated in certain eating disorders for children Pituitary Gland: regulates hormones including estrogen and testosterone (closely related to the immune system which protects us from disease, it is not surprising that it is implicated in a variety of disorders particularly health and dress ones The Pituitary Gland  stimulates the adrenal glands to produce epinephrine and the stress hormone known as CORTISOL  HYPOTHALAMIC PITUITARYADRENALAXIS (HPA)  this important feedback loop regulates our level of arousal and apprehension…and it can be disrupted or damaged by various traumatic and uncontrollable events Neurotransmitters Similar to biochemical currents in the brain Chapter Two Textbook 01/30/2014  they develop to make meaningful connections that serve large functions such as thinking and feeling “BRAIN CIRCUITS”  neurons that are more sensitive to one type of neurotransmitters tend to cluster together  brain circuits are paths from one part of the brain to another Brain circuits and neurotransmitters have been tied to particular psychological disorders but they also give certain pathways for treatment Like the influence of genetics, changes in the neurotransmitter activity may make people more or less likely to have certain disorders or behaviours but they do not cause it directly Neurotransmitter Function Implicated role in Disorder GABA Reduces arousal and Anxiety disorder moderates emotional responses DOPAMINE May act as a switch that turns Mood disorders, on various brain circuits, schizophrenia,ADHD allowing other transmitters to facilitate emotions or behaviour Norepinephrine Facilitates or controls Not directly involved with emergency reactions and anything in specific, it acts alarm responses, plays a role generally to regulate or in emotional and behavioural modulate behavioural regulation tendencies SEROTONIN Information and motor Eating/sleeping disorders, coordination, makes children OCD, mood disorders want to explore their surroundings moderates eating, sleeping, expressing anger Chapter Two Textbook 01/30/2014 Psychological Perspectives Emotions and affective expression are core elements of human psychological experience  emotion reactivity and regulation are critical aspects of early and subsequent development, affecting the quality of children’s social interactions and relationships throughout their life span  three major approaches to abnormal behaviour based on principles of learning 1. Applied Behaviour Analysis 2. Classical Conditioning 3. Social Learning/Social Cognition “Emotion Reactivity”  refers to individual differences in the threshold and intensity of emotional experiences, which provide clues to an individual’s level of distress and sensitivity to the environment “Emotion Regulation”  this involves enhancing, maintaining or inhibiting emotional arousal which is usually done for a specific goal or purpose **for example, Jorge was emotionally reactive to certain academic tasks (he became upset easily and couldn’t concentrate)  this emotional reaction could lead to poor regulation, resulting in him becoming distraught and difficult to manage Temperament (most of this is from tutorial lecture) An organized style of behaviour that appears early in development and shapes an individuals approach to his or her environment THREE PRIMARY DIMENSIONS 1. Positive affect and approach (emotional expression, how you say things) (smiling, wiggling, getting closer to stranger, engaging conversations) 2. Fearful or inhibited (“behavioural inhibition”, means the extent to which you are controlling your behaviour and thinking before you act, really inhibited may have restricted movements, might be quieter….NOT just quick to act, they are careful and cautious) 3. Negative affect or irritability (distress, sadness) Early building blocks of personality (attitudes, beliefs, cultural standards, more influenced by peers) “Self Regulation”  balance between emotional reactivity and self control Similarities in Children’s Early Behavioural Styles and Adult Personality and Wellbeing 1000+ children at age 3 and looked at their temperament along 5 dimensions: under controlled, inhibited, confident, reserved and well adjusted Chapter Two Textbook 01/30/2014 23 years later they conducted an assessment of these same individuals as adults and found some interesting consistencies Under Controlled: were rated as irritable, impulsive and restless and at age 26 they scored high on the traits linked to negative emotionality Inhibited: were fearful and easily upset, and at age 26 they were described as unassertive and took little pleasure in life **The remaining of the temperament groups did not display such dramatic profiles as adults  but a considerable amount of continuity in style did occur over time Confident: seen as friendly and ear to explore, and they were the least conventional and most extroverted as adults Reserved: described as timid and uncomfortable, and as adults they were unassertive and were seen as introverted WellAdjusted: behaved in an age and situation appropriate manner were the same as adults **RESULTS SUGGEST THAT CHILDREN”S EARLY BEHAVIOURAL STYLES FORECAST HOW THEY WILL TYPICALLY BEAS ADULTS Behavioural and Cognitive Influences Emphasize principles of learning and cognition, which shape children’s behaviour and their interpretation of things around them Applied BehaviourAnalysis (ABA) Operant Conditioning  B.F Skinner Known as the “functional approach” ABAdescribes and tests functional relationships between stimuli, responses and consequences Reinforcement Shaping (rewarding successes of behaviour) Punishment  have the effect of decreasing a response Extinction  have the effect of decreasing a response First thing you have to do is figure out what the behaviour you are talking about is And is it increasing or decreasing Is there a stimulus being applied or removed Spanking  something being applied, goal is to decrease behaviour (positive punishment) Come home late, miss curfew, lose phone for a week  loss of privilege…decreasing the lateness (negative punishment) Behaviour Applied Stimulus Removed Stimulus Chapter Two Textbook 01/30/2014 Increase’s + reinforced -reinforced Decreases +punishment -punishment Chapter Two Textbook 01/30/2014 What behavioural factors may have influenced Jeremy’s acquisition of language? (watching TV, mom not turning off TV maybe because mom’s behaviour is being negatively bugging is removed) (not talking…look at perspective of the mom or the child…  Define the behaviour  What contingencies are related to the behaviour? Classical Conditioning Based on LittleAlbert (chapter 1)  classical conditioning explains the acquisition of deviant behaviour on the basis of paired associations between previously neutral stimuli (math problems) and unconditioned stimuli (such as food)  any neutral stimulus can become a CONDITIONED STIMULUS if it is paired enough times with an event that already elicits a certain response Social Learning and Cognition  look at overt behaviours (like school problems)  ALSO the role of possible cognitive mediators that may influence the behaviours directly or indirectly BANDURA SOCIALLEARNING, behaviour may be learned by not only operant and classical conditioning, but also INDIRECTLY through observation “Social Cognition”  relates to how children think about themselves and others, resulting in the formation of mental representations of themselves, their relationships and their social world These are not fixed *** Family, Social and Cultural Perspectives Attachment approaches to abnormal child behaviour emphasize the evolving infant-caregiver relationship, which helps the infant regulate behaviour and emotions, especially under conditions of threats or stress Normal and abnormal development depends on a variety of social and environmental settings, including the child’s family and peer system, and the larger social and cultural context Children’s normal and abnormal development depends on social and environmental contexts PROXIMAL (close by) vs. DISTAL (further removed) factors + those that impinge directly on the child in a particular situation at a particular time Environment is constantly changing in relation to its many components Environmental Influences are then FURTHER subdivided into shared and non shared types Chapter Two Textbook 01/30/2014 Shared: refers to those factors that produce similarities in developmental outcomes among siblings in the same family Non Shared: which refers to the factors that produce differences among siblings  seems that the non shared factors contribute to a large portion of the variation Brofenbrenner’s Ecological Model  shows the richness and depth of the various layers of a child’s environment by portraying it as a series of nested and interconnected structures CHILD IS THE CENTRE OFTHIS SPEHERE of influence, which contains various levels interconnected in many ways Starts with family members and home surroundings, and grows to preschool, parks, friends Social settings also affect the child, even when the child does not directly experiences these influences (parent’s friends and jobs, how available support systems are)  finally far removed from the child’s day to day activities cultural ideology or identity governs how children should be treated ** THESEARE RECIPROCAL CONNECTIONS Infant- CaregiverAttachment Attachment  refers to the process of establishing and maintaining and emotional bong with parents or other significant individuals “Internal Working Model”  what the child expects from others and how he or she relates to others Attachment features constitute only one aspect of human relationships Type of Attachment Possible Disorder Outcomes Secure Although people with secure attachments may suffer psychological disorders, their relationship strategy serves as a protective function against disordered outcomes Insecure (anxious, avoidant type) Conduct disorders, aggressive behaviour, depressive symptoms (usually as a result of failure of self reliant image) Insecure (anxious resistant) Phobias, anxiety, psychosomatic symptoms, depression Disorganized/Disoriented (not an organized No consensus, but generally a wide range of strategy) personality disorders Chapter Two Textbook 01/30/2014 The Family and Peer Context Huge focus on the role of the family system, the complex system within families and the reciprocal influences “Family System”  theorists argue that it is difficult to understand or predict the behaviour of a particular family member, such as the child, in isolation from other family members RELATIONSHIPS are key  not always about the individual Chapter 3 01/30/2014 Research – Systematic way of finding answers to questions (follows certain rules) A Scientific Approach Reasons for skepticism 1. Experts on childhood problems frequently disagree 2. Research studies that appear in mainstream media are frequently oversimplified, and the way in which findings are presented can make them more or less believable 3. Often research findings conflict with each other 4. Research has led to different recommendations regarding how children with problems should be helped 5. Many parents and professionals may dismiss the findings (even if based on a consensus) because they have encountered an exception Accumulation of findings – not one study – that advances the field When Science is Ignored Facilitated communication (FC) – teaches children with autism and other impairments how to communicate Controversial/misused Provides manual assistance by lightly holding a child’s wrist, hand, or arm, while the child supposedly communicates via keyboard or by pointing to letters Purpose – to assist not influence; but possibility of a direct influence by the facilitator Results – far beyond their presumed abilities Ascientific approach to abnormal child psychology is a way of thinking about how best to understand and answer questions of interest, not just an accumulation of specific methods, practices, or procedures Scientific method requires that theories be backed up by evidence from controlled studies and that observations be checked and repeated before conclusions are drawn Facilitated Communication (FC) meets many of the criteria of pseudoscience because demonstrations of benefits are based on anecdotes or testimonials, the child’s baseline abilities and possibility of spontaneous improvement are ignored, and typical scientific procedures are denied What distinguishes science from pseudoscience is that scientists play by the rules of science, are prepared to admit they are wrong, and are open to change The Research Process Research in abnormal psych is best characterized as a multistage process: 1. Develop a hypothesis (research question) on the basis of observations, theory and previous findings; and decide on a general approach to research 2. Identify the sample, selecting measures, and research design and procedures Chapter 3 01/30/2014 3. Data collection and analysis and interpretation of findings Chapter 3 01/30/2014 Nature and Distribution of Childhood Disorders • Epidemiological Research – the study of the incidence, prevalence, and co-occurrence of childhood disorders and competencies in clinic-referred and community samples Incidence Rates – Reflect the extent to which new cases of a disorder appear over a • specified period • Prevalence Rates – All cases, whether new or previously existing, observed during a specified period of time o Estimates can be obtained over a short period of time (6 months) or over a longer period (lifetime prevalence – whether children in the sample have had the disorder at any time in their lives) Cases may be defined in terms of single symptoms, multiple symptoms, or patterns of symptoms Lifetime prevalence of mental disorders in double cases in retrospective studies (which are subject to recall failure) Prevalence rates also vary depending on whether cases are defined in terms of patterns of symptoms, impairment in functioning, or both Fewer cases are identified when both are used as the definition Rate and expression of childhood symptoms and disorders often vary in relation to demographic and situational factors (SES – social economic status) Conduct problems are more prevalent in low SES families –AfricanAmerican children over represented in this demographic Correlates, Risks, and Causes • 3 variables of interest in abnormal child psychology – correlates, risks and causes 1. Correlates – variables that are associated at a particular point in time with no clear proof that one precedes the other 2. Risk Factor – a variable that precedes an outcome of interest and increases the chances of a negative outcome i. Protective Factor – a positive variable that precedes an outcome of interest and decreases the chances that a negative outcome will occur ii. Research on risk and protective factors requires that large samples of children be studied and that multiple domains of functioning be assessed over long periods of time. iii. This is necessary because a. Only a small portion f children at risk for a problem will actually develop the disorder b. The areas of child functioning that will be affected are not known in advance Chapter 3 01/30/2014 c. The ages at which a disorder may occur or reoccur are also not know in advance (delayed/sleeper effects – when effects do not show up until later) 3. Causes – they influence either directly or indirectly through other variables, the occurrence of a behavior/disorder of interest Moderating and Mediating Variables • Difference between moderating and mediating variables – moderators have an independent effect on existing relationships between 2 variables, whereas mediators account for some or all of the apparent relationship between 2 variables • Moderating variables – influence the direction or strength of the relationship of the variables of interest o The association between 2 variables depends on or differs as a function of moderating variables (gender, age, etc.) • Mediator variables – the process, mechanism, or means through which a variable produces a particular outcome o Described what happens at the psychological or neurobiological level Interventions • Randomized Controlled Trials (RCTs) – children with a particular problem are randomly assigned to different treatment and control conditions • Treatment Efficacy – whether the treatment can produce changes under well-controlled conditions (i.e. careful control is exerted over the selection of cases, therapists, and delivery and monitoring of treatment) • Treatment Effectiveness – whether the treatment can be shown to work in clinical practice (done in a clinical setting, clients are referred rather than selected and therapists provide service without exerting controls used in research) Methods of Studying Behavior Standardization, Reliability, and Validity • Standardization – process that specifies a set of standards or norms for a method of measurement that are used consistently o Without standardization nearly impossible to replicate the info obtained and wont apply to other situations • Reliability – consistency, or repeatability, of results obtained using a specific method of measurement o Internal consistency – whether all parts of a method of measurement contribute in a meaningful way to the info obtained o Interrater reliability – various people agreeing on the info obtained Chapter 3 01/30/2014 o Test-retest reliability – the results need to be stable over time • Validity – the extent to which it actually measures the dimension or construct the researcher sets out to measure o Face validity – the extent to which it appears to assess the construct of interest o Construct validity – whether scores on a measure behave as predicted by theory or past research o Convergent validity – reflects the correlation between measures that are expected to be related o Discriminant validity – refers to the degree of correlation between measures that are not expected to be related to one another o Criterion –related validity – how well a measure predicts behavior in settings where we would expect it to do so – at the same time (concurrent validity), or in the future (predictive validity) Measurement Methods Reporting Assess the perceptions, thoughts, behaviors, feelings, and past experiences of the child, parents, and teachers Include relatively unstructured clinical interviews, highly structured clinical interviews, and questionnaires Self report measure – a child or parent will provide info about their own behaviors, feelings, or thoughts Informant-report measure – a person who is well acquainted with the child will provide info about child’s behaviors, feelings, or thoughts based on observation of the child Issues – selective recall or bias, inability to recall, intention distortions Children under the age of 7 or 8 are usually unreliable reporters of own behavior Psychophysiological Methods • Assess the relationship between physiological processes and behavior to identify which nervous system structures and processes contribute to children’s atypical development and behavior • Electroencephalogram (EEG) – links the brains measurable electrical activity with ongoing thinking, emotion, or states of arousal o Uses electrodes attached to the surface of the child’s scalp o Sleep disturbances and emotional states Neuroimaging Methods • Neuroimaging – used to examine the structure and/or function of the living brain Chapter 3 01/30/2014 • Structural brain imaging procedures include magnetic resonance imaging (MRI) and coaxial tomographic (CT) scans – study the brains anatomy • MRI – uses radio signals generated ina strong magnetic field and passed through brain tissue to produce fine-grained analyses of brain structures • CT – also reveal various structures of the brain • MRI and CT studies have led to the hypothesis of abnormal neural migration in children with ADHD • 2 types of functional imaging procedures 1. functional magnetic resonance imaging (fMRI) – a form of MRI that register neural activity in functioning areas of the brain. 3D image showing which areas are specialized for certain functions 2. Positron Emission Tomography (PET) – assess cerebral glucose metabolism. Glucose – brains main source of energy so measures how much is used to see brain activity • Diffusion MRI – magnetic imaging method that produces images showing connections between brain regions o Key technique in the creation of the human connection (the structure and organization of connections throughout the CNS) Observation Methods • Naturalistic observation – researcher can directly observe the behavior of the child and others under unstructured observation in the child’s natural environment • Structured observation – highly structured situations involving specific tasks or instructions usually carried out in the clinic or laboratory o Cost-effective o Permit the use of assessment procedures Research Strategies Internal validity – reflects how much a particular variable accounts for the results, changes, • or group differences o Threats to internal validity – extraneous variables o Subject-selection biases – factors that operate in selecting subjects or in the selective loss or retention f subjects during a study External Validity – the degree to which findings can be generalized, or extended, to people, settings, times, measures, and characteristics other than the ones in the particular study Identifying the Sample • Acareful definition of the sample is critical for comparability of findings across studies and clear communication among researchers Chapter 3 01/30/2014 • Comorbidity – the simultaneous occurrence of 2/more childhood disorders that is far more common than would be predicted from the general population base rates of the individual disorders Random selection – rare in abnormal psychology • • Samples of convenience – subjects are selected merely because of their availability, regardless of whether they are suitable General Research Strategies Nonexperimental and Experimental Research • Difference between the two – the degree to which the investigator can manipulate the experimental variable • Independent variable – manipulated by the researcher • Dependent variable –expected to be influenced by the independent variable • True experiment – the researcher has maximum control over the independent variable and has random assignment of subjects to groups Correlational studies – describes the degree of association between 2 variables • • Quasi-experimental designs/known group comparisons • Natural experiments – comparisons are made between conditions or treatments that already exist (correlational) Prospective and Retrospective Research • Retrospective Design – a sample of people is identified at the current time and asked for info relating to an earlier time o Individuals are identified who already show the outcome of interest and they are compared with controls who do not show the outcome o Highly susceptible to bias and distortion in recall Real-time Prospective Designs – research sample is identified and then followed over time, with data collected at specified time intervals Analogue Research • Evaluates a specific variable of interest under conditions that only resemble or approximate the situation for which one wishes to generalize • Focu on circumscribed research questions under well-controlled conditions • Often purpose is to illuminate a specific process that would otherwise be difficult to study Research Designs Case Study • Involves an intensive, usually anecdotal, observation and analysis of an individual child • Has a long tradition in abnormal child psychology • Rich in detail Chapter 3 01/30/2014 • Unscientific because of uncontrolled methods and selective biases and limited generalizability • Some disorders are rare aka difficult to find a large sample so good to use case studies Analysis of striking individual cases may contribute to understandings of infrequent or • hidden symptoms • Significant childhood disturbances can develop due to extreme events and circumstances and are difficult to study with controlled methods Single-Case Experimental Designs • ^ have most frequently been used to evaluate the impact of clinical treatment, such as reinforcement, on a child’s problem • systematic repeated assessment of behavior over time, replication of treatment effects within the same subject over time and the participant’s serving his or her own control by experiencing all treatment conditions • Most common single-subject design – ABAB Reversal Design – a baseline of behavior is taken (A), followed by an intervention (B), then a return to baseline where the intervention is removed (A), and a final phase in which the intervention is reintroduced (B) • When changes in behavior occur only in the intervention phases, this provides evidence that changes in behavior are due to intervention • Multiple-Baseline Design – different responses of the same individual are identified across behaviors and measured over time to provide a baseline against which changes may be evaluated (may be for different behaviors, situations, or individuals) Cross-Sectional and Longitudinal Studies • Cross-sectional Research – different children at different ages or periods of development are studied at the same point in time • Longitudinal Research – same children are studied at different ages or periods of development o Suffer from cohort effects (influences related to being a member of a specific cohort) and aging effects (general changes that occur because as participants age they change) Qualitative Research – • focuses on narrative accounts, descriptions, interpretation, context, and meaning • Purpose – Describe, interpret, and understand • Between-group designs compare the behavior of groups of individuals assigned to different conditions, such as an experimental group, or a comparison group and a control group Ethical and Pragmatic Issues • Informed Consent and Assent Chapter 3 01/30/2014 o Informed consent – requires that all participants be fully informed of the nature of the research o Assent – shows some form of agreement without necessarily understanding the full significance of the research o Guidelines for obtaining assent of the child call for doing so when the child is around the age of 7 or older – must provide school-age children with complete explanation of the research o Factors that require particular attention when seeking children’s assent include: age, developmental maturity, psychological state, family factors, and the influence of the investigator seeking assent Voluntary participation Confidentiality and anonymity Nonharmful procedures To ensure the research meets ethical standards, researchers seek advice from colleagues and have their research evaluated by institutional ethics review committees The final responsibility for the ethical integrity of any research project is with the investigator Chapter 5 ▯ ADHD  01/30/2014 Inattentive, hyperactive, impulsive Symptoms vary from child to child The disorder we now callADHD has had many different names, primary symptoms and presumed causes and views of the disorder are still evolving Description • Attention deficit disorder or ADHD describes children who display persistent age inappropriate symptoms of inattention, hyperactivity and impulsivity that are sufficient to cause impairment in major life activities • ADHD may be a new term in some cases, but children who display these qualities have been around for some time • Heinrich Hoffmann  German neurologists wrote in a child’s storybook one of the first known accounts of hyperactivity • Different cases over the span of 150 years…but the behaviours of both boys typifyADHD symptoms • INNATTENTIVE  not focusing on mealtime demands and behaving carelessly • HYPERACTIVE  constantly in motion • IMPULSIVE  acting without thinking • There are no physical symptoms that can be seen with an X-Ray or lab test  all about the characteristics of behaviour • Sometimes a child withADHD acts completely normal which is hard for people to sometimes understand because then why “do they need medication” • Achild withADHD may feel frustrated, think they are different and worry about not fitting in History • 1798  Alexander Crichton was one of the first to describe it a syndrome similar toADHD that included early onset, restlessness, inattention • 1902  over activity and inattention were described as a disorder by George Still  he believed these symptoms came from “inhibitory volition” and “defective moral control” • 1917-1926  influenza epidemic and people that survived developed some of the symptoms of ADHD and these people were labeled “brain injured child syndrome” • 1940’s and 50’s  called “minimal brain damage, minimal brain dysfunction” • late 1950’s  referred to as “hyper kinesis” which led to the definition “hyperactive child syndrome” • it was soon realized that hyperactivity was not the only problem though Chapter 5 ▯ ADHD  01/30/2014 • there is growing agreement about the nature ofADHD but still views are continuing to evolve as a result of new findings and discoveries…. Chapter 5 ▯ ADHD  01/30/2014 • Leads to thinking….well what the hell is it then and how can they even give meds if they are still evolving? Core Characteristics • DSM-IV uses two lists of symptoms to defineADHD • The first list includes symptoms of inattention, poor concentration and disorganization • The second list includes symptoms of hyperactivity-impulsivity • Children who are inattentive (IA) find it difficult to sustain mental effort during work and play • They find it difficult to resist salient distraction while do the above  while playing soccer the child who had ADHD might get distracted by a mud puddle  there are many different types of attention and the child could have a deficit in one or many types of these attention • Children withADHD are extremely active but unlike other children with a high energy level they accomplish very little • Children withADHD are impulsive, which means they seem unable to bridle their immediate reactions or they may fail to think before they act • DSM specifies three subtypes ofADHD based on primary symptoms of inattention, hyperactivity-impulsivity or a combination of both of those • Adiagnosis ofADHD requires the appearance of symptoms before the age of 7, a greater frequency and severity of symptoms than in other children of the same age and gender, persistence of the symptoms, occurrence of the symptoms in several settings, and impairments of functioning • Although useful, the DSM criteria has several limitations, including developmental insensitivity DSM Model • First list includes symptoms of inattention • Second list includes for hyperactivity-impulsivity • Each dimension includes many distinct processes that have been defined and measured in various ways • Although we discuss attention and impulse control separately, these two are closely attached developmentally Inattention Chapter 5 ▯ ADHD  01/30/2014 • Attention Capacity  is the amount of information we can remember and attend to in a short period of time  when someone gives you directions or a phone number  children with ADHD do not have a deficit in their attention capacity, they can remember the same amount of info for a short time as other children • SelectiveAttention  the ability to concentrate on relevant stimuli and not be distracted by task irrelevant stimuli around them • Distractibility  a common term for a deficit in selective attention  distractions can be disruptive to all children, but kids withADHD are much more likely to be distracted  stimuli will be “highly salient and appealing” • Sustained Attention  or vigilance is the ability to maintain a persistent focus over time or when tired  primary attention deficit inADHD seems to be this time…we all hate stupid tasks but we do them anyways, children withADHD wont  these types of attention deficits are core inADHD, but children withADHD might show performance deficits from the very beginning of a task, not just over a period of time ****SHOWS THE PROBLEM MAY BEALERTINGAND PREPARING FOR THE • TASK • Alerting  an initial reaction to a stimulus and involves the ability to prepare for what is about to happen  they may respond too quickly to something that requires a slower approach Hyperactivity-Impulsivity (HI) • Most children if they display one, they display the other • Strong link between the two suggests that both are part of a fundamental deficit in regulating behaviour Hyperactivity • Sitting still in class is really hard Fidget, squirm, climb, run • • Excessively energetic and they don’t get anything productive don’t • Even when they sleep these children have more body moments…largest differences are found in situations where the child is required to inhibit motor activity (slow down or sit still) • Primary impairment is an inability to voluntarily inhibit dominant or ongoing behaviour in order to meet situational needs Impulsivity • Seem unable to bridle their immediate reactions or think before they act  may take a part an expensive clock without thinking about how they were going to put it back together • Difficult to take turns, they interrupt • Injuries can result from reckless behaviour  running into the street without looking Chapter 5 ▯ ADHD  01/30/2014 • Cognitive Impulsivity  reflected in disorganization, hurried thinking, and the need for supervision  john didn’t know to hand in his homework even though it was completed • Behavioural Impulsivity  includes impulsivity calling out in class or acting without considering consequences  touch a stove even though they know it’s hot  only BI predicts rule breaking behaviour and may be a sign of increased risk for conduct problems • Emotional Impulsivity  reflected in impatience, low tolerance, hot temper Subtypes • Subtype  is a group of individuals with something in common  symptoms, etiology, problem severity or likely out come that makes them distinct from other groupings • found that 50 percent of ADHD cases are reclassified from one subtype to another depending on the number of people reporting on the child’s symptoms, the methods used to assess and how info across reporters and methods was combined • issues remain regarding the reliability and validity of the discrete subtypes specified in DSM- IV • Predominantly inattentive type (ADHD-PI)  mostly inattention issues • Inattentive and drowsy, day dreamy, spacey • Predominantly hyperactive-impulsive (ADHD-HI)  primarily symptoms of hyperactivity- impulsivity • More likely to display problems in inhibiting behaviour and in behavioural persistence • Combined type (ADHD-C)  have both of the above  the ones most often referred to for treatment (usually younger children and limited validity for older children) Additional DSM Criteria • Not every child with these symptoms hasADHD To diagnoseADHD the person must  appear before age 7, occur more often and with greater • severity that in other children of the same age and sex, occur in several settings, produce significant impairments in the child’s social or academic performance • Traumatic experiences can cause behaviour that mimicADHD, does not mean it is • It is very important to analyze all aspects of the child and their history before diagnosing What the DSM Criteria Don’t Tell Us Developmentally Insensitive  it applies the same symptoms to individuals of all ages, even though running and climbing apply probably more to younger children Chapter 5 ▯ ADHD  01/30/2014 Categorical View  according to DSM,ADHD is a disorder that you either have or don’t have… because the number and severity of symptoms are also calculated on a scale, children who fall just below the cut off forADHD are not necessarily different from children just above the cut off  for example there is not magic cut off for high blood pressure, but most of use would agree that people with high blood pressure at greater risk or negative things Requirement of an onset of symptoms before age 7 is arbitrary and very restrictive  half of children aren’t even identified as ADHD+ until after age 7…extending age from 7 to 12 does not change the overall prevalence of ADHD Associated Characteristics • Besides primary difficulties, children withADHD display other problems such as cognitive and learning deficits, speech and language impairments, motor incoordination, medical and physical concerns and social problems • Children withADHD display deficits in executive functions, the higher order mental processes that underlie the child’s capacity for planning and self regulation • Executive Functions  cognitive processes in the brain that activate, integrate and manage other brain functions  underlie things like self awareness, planning, self monitoring, self evaluation Four Types of Executive Functions • Cognitive Processes  working memory, flexibility of thinking, organizational strategies • Language Processes  verbal fluency, self directed speech • Motor Processes  allocation of effort, following prohibitive instructions, sequencing • Emotional Processes  self regulation of arousal level and tolerating frustration • Children withADHD score slightly lower on IQ tests, but most are of normal intelligence. Their difficulty lies in applying their intelligence to everyday situations  many are quite bright  difficulty lies in applying their knowledge • Children withADHD experience school performance difficulties, including lower grades, a failure to advance in grade, and more frequent placements in special Ed classes • Many children have a specific learning disorder, typically in reading, spelling or math • Distorted Self Perception: Some children report higher self esteem than is warranted by their behaviour, referred to as a POSITIVE ILLUSORY BIAS…they tend to see things better than they are Positive Illusory Bias • Serves as a self protective function • Result of not knowing what constitutes successful or unsuccessful performance Chapter 5 ▯ ADHD  01/30/2014 Impaired Executive Function Resulting Impairment 1. Organize, prioritize and activate Trouble getting started, difficulty organizing work, misunderstand directions 2. Focus, shift and sustain attention Lose focus when trying to listen, forget what has been read and need to re-read things, easily distracted 3. Regulate alertness, effort, and processing Excessive daytime drowsiness, difficulty speed completing a task on time, slow processing speed 4. manage frustration and modulate emotion very easily irritated, feelings hurt easily, overly sensitive to criticism 5. working memory and accessing recall Forget to do a planned task, difficulty following sequential direction, quickly lose thoughts that were put on hold 6. Monitor and regulate action Find it hard to sit still or be quiet, rush things, slap dash, often interrupt, blurt things out Chapter 5 ▯ ADHD  01/30/2014 Quality of Life • Display distortions in their perceptions of quality of life  which refers to a person’s subjective perception of their position in life as evidence by their physical, psychological and social functioning • **children withADHD who display inattentive and depressive/anxious symptoms tend to report lower self esteem • **children with symptoms of hyperactivity impulsivity and conduct problems appear to exaggerate their self worth Speech and language impairments • have difficulty using language in every day situations • also have difficulty understanding others, let alone getting things out themselves • excessive loud talking, interrupting, inability to listen  all examples of some of their impairments May display motor coordination difficulties and tic disorders • coordination difficulties • overlap exists between ADHD and developmental coordination disorder (DCD) • 20 percent of children withADHD have tic disorders…sudden, repetitive, issues with motor movements or sounds such as eye blinking, facial grimacing • if children have these then they tend to have more issues than those withADHD alone Medical and Physical Concerns • experience health related problems, especially sleep disturbances and they are accident prone • Experience numerous social problems with family members, teachers and peers Health Related Problems Higher rates of asthma • • Sleeping issues (going to bed, not getting enough sleep, movement disturbances)  might have something to do with stimulant medications Accident Proneness and Risk Taking • Problem with impulsivity and lack of planning not surprising that they are accident prone • 3X more likely to have physical accidents • driving is potentially dangerous • ADHD is a risk factor for substance use, and having multiple partners and unprotected sex • These findings suggest a progression of hyperactive impulsive behaviours during childhood to a pattern of irresponsible and risky adult behaviour • Average medical costs seem to be double those withoutADHD Chapter 5 ▯ ADHD  01/30/2014 Social Problems • Find things to do that other kids just would never ever think of “don’t carve soap with the potato peeler” • Those who experience the most sever social disability are at greatest risk for poor adolescent outcomes and other disorders  like depression • Children withADHD do not play by the same social rules • Might have good intentions but their behaviours sometimes have annoying qualities Family Problems • Many difficulties within families  non compliance, excessive parental control, sibling conflict • Most commonly depression in mothers and antisocial behaviours such as substance abuse in the father • Families of children withADHD said there were issues in all other factors of family life (for example, seeing extended family) • Increased alcohol consumption • Siblings sometimes feel bullied by theADHD child but this gets overlooked Peer Problems • Evident at an early age • Don’t display the give-take characteristic that other children tend to have • Socially awkward and easily upset, so hard to form friendships • Seem to get in trouble even if they are trying to be helpful • Not surprising that they are disliked and rejected by peers • The social problems of these children may increase their risk of later disorders other than ADHD and spill over into other areas of development They don’t know how to act in social exchanges • • Despite these social problems  some withADHD may meet their social needs by maintaining one or two close friendships • Positive friendships may buffer the negative outcomes of peer rejection commonly seen in children withADHD • Alot of research on peer relationships  not a lot on close friendships which is important and should
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