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50 Cards in this Set
- Front
- Back
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Internalizing vs externalizing behaviour in boys and girls.
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- girls tends to be internalizers
- boys tend to be more externalizers - the externalizers are the ones who stand out the most, and the internalizers may go un-noticed |
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What makes children misbehave in school?
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- bordom
- activity you have them engaged in is not appropriate for them developmental age - ADHD - hypersensitive to whats going around in their environment so easily distracted - hunger, lack of sleep - Immaturity - learning or developmental disabilities - psychiatric/emotional disturbances NB lack of discipline is NOT an etiology |
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Define: Attention
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- act or state of attending esp though applying the mind to an object of sense or thought
- readiness for such attention esp selective narrowing or focusing of consciousness and receptivity |
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Benefits of attention
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- cognitive/academic effectiveness
- behavioural adaptation - social/interpersonal success |
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What is involved in mental energy controls?
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- alertness
- mental effort - sleep-arousal balance - performance consistency |
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What processing controls regulate the use of incoming information?
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- saliency determination
- depth and detail of processing - cognitive activation - focal maintenance - satisfaction level |
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Saliency determination
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discriminatino bw important and unimportant information
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Depth and detail of processing
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focusing with sufficient intensity to capture specific information
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Cognitive activation
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linking information with prior knowledge and experiences
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Focal maintenance (attention span)
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sustaining concentrations for the appropriate amount of time
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Satisfaction level
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focusing sufficiently on activities or topics of lower levels of interest
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Production controls that regulate academic and behavioural output
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- previewing
- facilitation/inhibition - pacing - self-monitoring - reinforce-ability |
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Previewing
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anticipating likely outcomes of actions, events,
and problems |
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Facilitation/inhibition
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Selecting the best option before acting or starting a task
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Pacing
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doing tasks at the most appropriate speed
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Self-monitoring
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watching one’s own output and making
necessary modifications |
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Reinforce-ability
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using previous experience to guide current behaviour
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DSM-IV diagnostic criteria for ADHD (symptoms of inattention)
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(1) six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is MALADAPTIVE and INCONSISTENT with DEVELOPMENTAL LEVEL
- close attention to details - difficulty sustaining attention - does not seem to listen - does not follow through on instructions - difficulty organizing tasks - poor sustained mental effort - loses things necessary for tasks or activities - easily distracted - often forgetful |
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DSM-IV diagnostic criteria for ADHD (symptoms of hyperactivity-impulsivity)
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six (or more) of the following symptoms of
hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level - fidgets - leaves seat in classroom - runs about or climbs excessively - difficulty playing or engaging in leisure activities quietly - often “on the go” - talks excessively |
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DSM-IV diagnostic criteria for ADHD (symptoms of impulsivity)
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- blurts out answers
- difficulty awaiting turn - interrupts or intrudes on other |
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DSM-IV diagnostic criteria for ADHD : onset of symptoms
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Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years
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DSM-IV diagnostic criteria for ADHD : trigger for symptoms
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Some impairments from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
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DSM-IV diagnostic criteria for ADHD : evidence
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There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning
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3 types of ADHD
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- Combined Type [1A+1B]
- Predominantly Inattentive Type [1A] - Predominantly Hyperactive-Impulsive Type [1B] |
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Prevalence of ADHD
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ADHD is the most commonly diagnosed neurobehavioral disorder of childhood
- 8% - 15% of North American children - male : female 3:1 |
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Proposed etiologies of ADHD
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Precise etiology not proven
- Genetic [Children with one parent with ADHD may have as high as a 50% chance of having ADHD] - Dopamine pathway - dopaminergic medications have been useful in ADHD - Noradrenergic System - norepinephrine affects attention & alertness Seratonin Pathway - seratonin targeting drugs have not been proven to be generally helpful Environmental Injury: Pre and perinatal insults. Traumatic brain injury, Toxins – alcohol, cocaine |
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Effect of poor parenting and psychosocial stressors on ADHD
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- not causal but may worsen symptoms
- kids in familys of higher SES well have better prognosis for their ADHD (more opportunities, learning support, more available parents) |
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Possible lifestyle factors that may improve prognosis of ADHD
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- food additives?
- exercise - time in nature - diet (omega 3 fatty acids!!) - relaxation techniques (mindfulness) |
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Pathophysiology of ADHD
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- small decreases in the size of certain brain areas
- loss of normal asymmetry (areas in right hemisphere normally larger than left) - No consistent findings - Functional imaging studies implicate the prefrontal cortex, anterior cingulate and the striatum |
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Differential diagnosis of crying and irritability
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- Sensory Deficit
- Receptive Language Problem (big one)* - Other Specific Learning Disabilities [coexist in 12- 60%] - Seizures - Mood Disorders – coexist in many children with ADHD - Anxiety Disorders – coexist in 25% - Oppositional Defiant Disorder, Conduct Disorder – coexists in 35% of children with ADHD - Parent – Child Interaction Problems - Intellectual Disability/Mental Retardation - Abuse – sexual, physical - Neglect |
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Treatment for ADHD
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1. Education (parent, child, teacher)
2. Psychological support 3. Behavioural modification/management: class and at home 4. Lifestyle: activity and sleep 5. Medical therapy: stimulant med and others |
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Rx for ADHD: meds or behaviour management?
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Just Meds = behavioural management + meds > behaviour tx or community based tx alone
First line tx: stimulant medication |
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Predictors of adult outcome
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- Family socioeconomic status
- Child’s intelligence - Degree of childhood conduct problems - Degree of peer relationship problems - Extent of parental psychopathology |
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Long term outcomes of ADHD
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- Significant persistence into young adulthood, especially in children from low SES.
- Can remit in childhood or early adolescence - Family adversity increases the risk of ADHD persisting over time |
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Prevalence of severe learning disabilities
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In BC, 3% of children are designated as having a Severe Learning Disability (The actual number is probably around 10%).
** Severe means statistically significant in test scores |
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Learning Disability Definition
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- Average to above average intelligence (but you learn differently)
- Lower achievement than would be predicted based on intelligence - Have processing difficulties |
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Learning Disability Etiology
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Not known, but probably genetic.
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Diagnosis of Learning Disabilities
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- full psychoeducational assessment
- 4 1⁄2 years or later (get an idea) - child is in school - hard to definitively diagnose until 6 yrs at the earliest |
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FASD: Prevelance
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1/100
- most common diagnosable cause of intellectual handicap in NA - 100% preventable!! |
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FASD: characteristics
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- Growth
- Face - Brain |
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FASD: growth deficiency features
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- Low birth weight if drinking was in late pregnancy
- Postnatally there is less than adequate weight gain despite adequate caloric - Disproportionately low weight compared to height |
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FASD: most specific facial features
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- Short palpebral fissures (increased distance bw the eyes)
- Flattened philtrum -Thin upper lip |
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Mechanisms for how alcohol affects the brain
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- Neural crest cells migrate from primitive brain toward the face, forming many structures including facial cartilage and bones
- Mid-face anomalies are sensitive markers of underlying altered brain morphogenesis |
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Significance of FASD facial features?
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- pretty much a sure sign the brain has been affected
- almost every child that has facial features will have signs of brain dysfunction at some point |
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FASD: functoinal impairment
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- Often an invisible disability
- majority of children have average to just below average intelligence - 85% of adults with FASD can’t live independently |
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Whats worse for the fetus, heroin or alcohol?
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Alcohol is worse!!
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What is a safe amount of alcohol during pregancy?
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There is no safe amount!!
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Three key features of autism specturum disorder
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1. Disordered social skills
2. Disordered communication skills. 3. Restricted interests/stereotypic behaviour |
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Asperger's syndrome: What is it? CFs? DDx?
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A type of Autism Spectrum Disorder
- Also called High Functioning Autism, won’t be included as a separate entity in DSM-V - Children present with poor social skills, restricted interests, with pragmatic language difficulties, as “odd” children - Differential diagnosis: language disorders, non-verbal learning disabilities, variation on “normal” |
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Asperger's syndrome: key social, communication, behavioural, motor and sensory features
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- Social: don’t make friends, struggle to read facial expressions or understand feelings
- Communication: often speak in a monotone voice, don’t understand idiom, metaphors or “higher level language” - Behaviour: may have stereotypies, restricted range of interests - Motor: often clumsy - Sensory: can be very hypersensitive |
