Psy 5305 Developmental Psychopathology Exam I

Front 1

What other approaches, besides the DSM, have been taken to classify the heterogeneous
nature of conduct problems, and how do these approaches (and their outcomes/results) compare
to the DSM-IV approach of classifying conduct problems in youth?

Back 1

1. Agressive behavior & Delinquent behavior
-NEED TO FIND INFO FROM DIMENSIONAL CLASSIFICATION READINGS

2. Covariation of Symptoms/Behaviors
-there are overt/covert and destructive/nondestructive types of sxn
-sxn of CD= variable, some are overt, others covert; some destructive, others not.
-sxn of agressive behavior= covaries independently of covert dimension; the agressive things cluster.
-there is evidence to suggest that first come oppositional sxn, then agressive, property, and then status. This suggests that the dimensions are seperate.
*Agressive behavior covaries independent of the rest of it.
*ODD (which I think can also refer to CD) clusters on ODD stuff.

3. Hierarchical Models of Externalizing Behavior
a) antisocial behavior
b) conduct disorder
c) substance dependence
d) Disinhibition/lack of constraint
-There is a highly heritable externalizing factor. There are also etiological distinctions for the specific syndromes & problems.
*Shared environmental factors only emerged for CD (not for antisocial, substance use, etc). There were independent nonshared environmental effects that were not associated with family.

How does this compare to the DSM-IV approach of classifying conduct probs in youth?
-In dimensional, problems are quantitative while in DSM, probs are absent/present
-In dimensional, syndromes are derived from problem scores, while in DSM, criteria are chosen by pannel of experts.
-In dimesnsional, clinical cutpoints are based on data for gender, age, and source of data; in dsm clinical cutpoints are same for both genders, diff ages, and diff sources of data
-in dimensional, clinicans use standardized forms; in categorical, clinical choses source of info
-in empirical, there is cross informant comparison of scores/profiles, but DSM does not specify procedure for comparing data from diff sources
-in dimensional, end product is multiinformant item and syndrome scores displayed as norm referenced profiles; in dsm, end products are diagnoses that are judged as absent vs present

Front 2

What are some research findings ON BOTH SIDES OF the nature (biological/genetic) versus
nurture (environmental/learning) debate on conduct disorder/antisocial behavior/aggressive
behavior??

Back 2

Genetic:
-Genetic factors exert a major influence upon antisocial and agressive behavior/disorders
-In one multi-informant study of child behavior that measured 18 different types of antisocial behavior, a common genetic antisocial behavior factor was discovered for which the heritability estimate was 96%. This genetic antisocial behavior factor exerted its effects across gender, for all informants combined.

Environmental Influences:
-examples include parent-child intxn, peer intxn, peer rejection, parenting, parental psychopathology, child effects, social information processing biases.
-peer rejection is related to early onset conduct disorder/agression and ADHD (especially the combination).
In other words, early peer rejection is related to later conduct problems.
*Some studies have found that the link between peer rejection and later conduct problems may be due to comorbid ADHD sxn.
-Social info processing biases
CD may have defects in how they process info in social situations. Social info processing model has five steps: encoding, interpretation deficits, response search deficits, enactment deficits.
-Parenting can be linked to problems, for instance, Inconsistent discipline (w/in parent and between parents), poor supervision/lack of monitoring, lack of parents involvement in kid's activities, harsh and abusive forms of discipline.
-Patterson's coersion theory states that antisocial behavior is learned through interacctions between family members. Family members teach and train each other to be agressive/coercive in chains of interaction that escalate over time.

Front 3

3. What are the specific sex differences in Conduct Disorder, and what does the empirical
literature offer in terms of explanations for WHY (or why not) these sex differences are present
(how they come about, causes of, etc.)??

Back 3

While much of the general literature concerned with the effects of early conduct
problems on later life outcomes is likely to apply to young women, there are at least
two reasons why gender specific variations may also exist. First, it is possible that the
linkages between early conduct problems and later life outcomes may differ with
child gender, leading to different outcomes for boys and girls with early conduct
problems. Conflicting evidence exists concerning the moderating effect of gender,
with some studies suggesting that conduct disordered girls and boys show a broadly
similar pattern of outcomes (e.g., Cairns & Cairns, 1994; Robins & Price, 1991
Zoccolillo, et al., 1992), whereas others have argued that the longer term prognosis
may be more favourable for girls than for boys (e.g., Kellam, Simon, & Ensminger,
1983; Lefkowitz, Eron, Waldron, & Huesmann, 1977). More recently, a study by
Fergusson, Woodward, and Horwood (2000) which examined gender differences in
the associations between early conduct problems, later criminality and substance use
found evidence to suggest that conduct problems in boys may be more predictive of
later crime, while for girls these problems may be more predictive of cigarette
smoking. No gender differences were found in the relationships between early
conduct problems and later alcohol and cannabis use. In general, these findings tend
to suggest that at least for some outcomes, gender differences may exist in the
associations found between early conduct problems and later outcomes for boys and
girls.
Second, it is likely that young women will be more vulnerable to, and affected
by, adverse sexual outcomes such as teenage pregnancy and sexual victimisation. For
example, studies have shown that conduct disordered girls have a three to five-fold
increased risk of an early pregnancy compared to girls without a prior history of early
conduct difficulties (Bardone, et al., 1996; Kovacs, Krol, & Voti, 1994; Woodward &
Fergusson, 1999). In view of women’s likely continued care-giving responsibility for
young children, the declining popularity of teenage marriage, in addition to an
increased likelihood of welfare dependence for early parenting young women, these
experiences are likely to have a substantial impact on the longer term life course
outcomes of girls with early conduct problems (Brooks-Gunn & Chase-Lansdale,
1995; Harris, Brown, & Bifulco, 1987).
findings. First, there is
clearly a need for greater recognition of the fact that girls are also at risk of antisocial
behaviour problems, and that these difficulties are likely to have a pervasive impact
on their longer term educational achievement, social adjustment and mental health.
Second, services that are capable of recognising and addressing the difficulties
associated with conduct problems in girls ought to be developed. While these
problems may present in a similar way to male conduct problems and appear to have
similar consequences, it is likely that there are gender specific features of the disorder
that require particular attention (Eme, 1992; Eme & Kavanaugh, 1995; Fergusson et
al., 2000; Giordano & Cernkovich, 1997). As we note above one of these features is
likely to be the greater vulnerability of conduct disordered girls to early onset sexual
intercourse, teenage pregnancy and other problematic sexual outcomes. Although it
is likely that parallel results may hold for males, it seems likely that these sexual
problems, and particularly, teenage pregnancy will have a more substantial impact on
the life course outcomes of young women and their offspring. Finally, the present
study suggests that there is a broad spectrum of problem behaviours in girls ranging
from none to severe, with risks of later adverse outcomes tending to increase with
increasing levels of severity of these behaviours. This dimensional model clearly
suggests the need for a range of treatment and management strategies that are capable
of dealing with a spectrum of conduct problems in girls, with this spectrum ranging
from mild to severe disturbance.

Front 4

4. What empirical findings suggest that: 1) depression leads to conduct disorder or conduct
problems in boys and/or girls, and 2) conduct disorder or conduct problems lead to depression in
boys and/or girls?

Back 4

1. Here are the empirical findings that suggest that depression leads to conduct disorder or conduct
problems in boys and/or girls:
-Lahey found that CD sxn are associated with later depression, and depression is associated with CD in boys
*CD & Depression are associated both concurrently and prospectively (i.e., over time).
-Other research suggests that the idea that there is a stronger association for Depression leading to CD than there is for CD leading to Depression.
*There is a lot of individual variability in whether CD or depression comes first.
In a seperate Lahey study w/ boys: CD sxn predicted later levels of depression after they controlled for initial CD. (They did not find the flip side, in that depression did not predict later CD).
-Weisner - CD lead to depression more for boys, for girls it went both ways.
-Ingoldsby investigated Patterson's dual failure model (i.e., disorder interferes with social and academic competence. They did not find support for this model (but they may have started to assess too late).

Front 5

5. What empirical findings suggest that: 1) ADHD leads to conduct disorder or conduct
problems, and 2) conduct disorder or conduct problems lead to ADHD?

Back 5

ADHD tends to preceed CD. Some studies demonstrate that this is only true if ADHD sxn persist over time.

Manuzza - ADHD was an early risk factor for CD in adolescence.

Drabick study - In boys with ADHD, parenting behavior, child enviro, achievement, social problems was associated with having CD & Depressive symptoms. In these ADHD boys, parenting behaviors (harsh and detached) were specific, unique RF for developing later CD.

In another study of boys with ADHD, predictors of dev of CD over time included:
pos parenting (protective).
mom's depression
neg parenting did not predict.

DON'T KNOW IF I HAVE ANY EVIDENCE THAT SUGGESTS CD->adhd, MOST OF WHAT I FOUND SUGGESTS ADHD->CD

Front 6

6. Remember those main 4 possible explanations for "true" comorbidity (described in class,
noted in Angold article)? Make an empirically-informed argument for precisely how EACH of
these 4 explanations may account for, and/or be applicable to, the comorbidity of Conduct
Disorder and ADHD

Back 6

How does ADHD/CD differ from ADHD alone, and should it be a
separate DSM category??
Comorbid ADHD/CD(in comparison to Pure ADHD Group)is:
--more at risk for later substance abuse (Molina & Pelham, 2003)
--increased rates of mother depression, anxiety, and drug
dependence; and father Conduct disorder and alcohol problems
(Chronis et al., 2003; listed as optional reading on syllabus)
--Associated with poorer family disturbance (other stuff like
parenting, marital conflict, other disorders in parents,
siblings, and extended relatives)
--More rejected by peers (sociometric scales)
--associated w. poorer outcome
--more likely to persist over time
--earlier age of onset
-greater male-female sex ratio
--Lower IQs
--More Learning Disabilities/problems
--More neuropsychological deficits (need more research on this)
--Responds poorer to meds than pure ADHD group

Front 7

7. Remember those main 4 possible explanations for "true" comorbidity (described in class,
noted in Angold article)? Make an empirically-informed argument for precisely how EACH of
these 4 explanations may account for, and/or be applicable to, the comorbidity of Conduct
Disorder (or ODD) and Depression.

Back 7

The four possible explanations for true comorbidity:
1. shared risk factors
2. seperate but co-occuring risk factors
3. one disorder creates the risk factor for the development of the other disorder
4. the comorbid pair is different from both pure groups (and should consequently be considered a seperate disorder.

1. Shared RF: genetic influences, parent's psychopath
-Subbaro (2008)- It seems that CD and depression share genetic RF (and non-shared environmental influence).
-Parents Psychopath: Parents of CD kids tend to have high rates of mom depression, antisocial PD in eaither parent, father's substance abuse
-Ollendick (2006)-Overall,
according to the model, common risk factors give rise
to either disorder, while unique factors differentiate
between these conditions. Various combinations of
these unique and common risk factors may contribute
to comorbidity
Marmostein and Iacano - looked at family relationship risk factors and tried to determine which were common to CD and depression. The three common risk factors that they discovered were: mom's depression, dad's antisocial, and parent-child conflict.
-In a study that used depr and CD checklists the two biggest risk factors (in girls and boys) for co-occuring depression and delinquency were: stressful life events, early childhood externalizing behavior. The also found that >60% of the covariation between these symptoms was due to common risk factors.

2. Seperate but co-occuring RF:
-(For example: Depression RF from mom & Antisocial RF from dad = Comorbid depression & Conduct disorder)
-In Kopp & Beachaine (2007):
Both mom's depression and dad's antisocial were independently related to kids Depression & to Kid's CD; An interaction was evident in which Dad's antisocial was related to CD no matter what mom's level of depression; kids in the depression group did not differ in mom's depression from those in CD group which suggests that depression may be a common RF.
*Seperate but co-occuriing RF- kids in comorbid depress/CD grp were more likely to have dads with antisocial and moms w/ depression relative to CD only, controls, or depression only.

3. One disorder predates the risk for another one.
(For example, CD->peer reject->depression)
In Ingoldsby (2006): Kids in the CD & depression comorbid group had poorer academic and social competence over 2 yrs; their sxn persisted over time, had more severe sxn and worse outcomes than kids with just CD or just depr
-(Kreager: looked at genetic and environmntal influences on substance abuse and found common genetic factors accounting for substance abuse and antisocial). Not so sure about this one.

Here is info for the the comorbid pair is different from both pure groups idea:
How does comorbid pair differ from both the pure groups??
Ezpeleta et al. 2006: (disorders in outpatient 8-17 year olds in
Spain; DEP only; CD/ODD only; and BOTH CD/ODD and DEP)
Review Past studies:
Comorbid in comparison to DEP: more substance abuse; worse
outcomes; fewer emotional problems/symptoms
Comorbid in comparison to CD: More suicide attempts, substance
abuse, worse outcomes (but many studies say similar outcomes),
less aggressive;
Comorbid in comparison to pure CD or DEP: More impaired, poorer
school achievement, lower social competence.
Found
-Few differences in other disorders (ADHD, SEPAX, GAD) between gps. In other words, Comorbid grp did not have higher rates of ADHD or sep anxiety.

Comorbid grp Higher than DEP on 8/11 CBCL scales; but Comorbid
group only higher than CD on a few (anx/dep, somatic, and
internalizing)
--Comorbid more impaired than CD on all global
impairment/functioning measures, psychopathology, mood, and selfharm;
Comorbid more impaired than DEP on only one of the 4
impairment/functioning measures, school, home, relationships with
others.
See Table, page 710, for summary:
--Comorbid in comparison to CD: More angry and resentful, used
weapons less, set fires more, more somatic complaints and anxiety
and more functionally impaired
--Comorbid in comparison to DEP: less sleep problems, more
somatic complaints, more severe anxiety symptoms, and more
impairment at school, home, and in relationships.

They concluded: Comorbid CD and DEP do NOT constitute a disorder
separate from either pure CP or DEP. There really were not
different patterns in the pure and comorbid groups; disorders
manifested with similar numbers of symptoms whether they were
present alone or comorbidly. Impairment differences were NOT
caused by severity of symptoms or higher levels of symptoms.
All in all, "comorbid disorders did not differ dramatically from
either pure depression or pure conduct problems" (page 711) .
Supports DSM-IV having separate CD and DEP and not depressive
conduct disorder (mixed category) as in the ICD-10

Front 8

8. What do we know about the stability and persistence of Conduct Disorder or severe conduct
problems over: 1) short intervals of time, and 2) over longer intervals of time?? Why might the
stability differ for shorter versus longer time periods??

Back 8

1. What we know about the stability/persistence of conductuct problems over short intervals of time:
*Short time intervals may not reflect the stability of behavior over time because of measurement errors
-Lahey used the DSM criteria to aks: Of boys who had CD at time 1, what proportion had CD a yr later? (51%). Of boys who had CD at time 2, what proportion had it at time 3? (48-51%). However, ppl who have it at time 1 may not be the same ppl who have it at T 5. It is not that 50% of cases cease to have it as time goes on: 88% of those who have it at T1 did meet criteria for CD again at some pt (T1, T2, T3, T4, or T5). *In other words, it is more stable than the 50% would indicate.

2. What do we know about the stability and persistence of Conduct Disorder or severe conduct problems over longer intervals of time?
-Several different variables are related to the persistence of behavior over time: extremely high rates of antisocial behavior/conduct problems, antisocial behavior in more than one setting, higher variety of behaviors, early onset, combo of ADHD & agression, parental psychopathology (particularly APD), peer rejection (probably more for early onset kids)

(I have other details in notes that I did not add here- refer to notes from 10.13.08 pg 3-4 if needed).

Why does the stability differ? Different factors may be related to short term sxn presentation than are related to persistence over time. DON'T KNOW THIS FOR SURE, MAY NEED TO ADD/MODIFIY

Front 9

9. What kinds of "problems" does the research indicate that boys and girls with Conduct
Disorder and/or conduct problems are at risk for in adolescence and adulthood??

Back 9

-Early childhood CD was related to criminal offenses, substance dependence (nicotine but not alcohol), antisocial PD, suicide attempts, mental health probs, relationship probs (multiple sex partners, early preg, partner violence), low educational achievement, employment difficulties.

Front 10

10. What variables does research suggest are related to the persistence of conduct disorder/
antisocial behavior over time? What makes a difference in terms of whether or not this kind of
behavior will persist over time?

Back 10

-Several different variables are related to the persistence of behavior over time: extremely high rates of antisocial behavior/conduct problems, antisocial behavior in more than one setting, higher variety of behaviors, early onset, combo of ADHD & agression, parental psychopathology (particularly APD), peer rejection (probably more for early onset kids)

Things that make a difference (I made these up):
age of onset
gender
presence/absence comorbidity

Front 11

11. How does Child-Onset and Adolescent-Onset Conduct Disorder differ from one another
(besides age of onset! !)? (i.e., what differences are found between them to support them being
separate subtypes in the DSM classification system?)

Back 11

Research finds that in comparison to adolescent-onset CD, child onset CD has:
-earlier onset
-is less prevalent
-consists of more males
-more agressive & violent behaviors
-more antisocial behaviors (both in the CD child and their siblings)
-more CD behav listed in DSm for child onset
-more ADHD
-more school achievement probs (even if they don't have learning disorders)
-more learning disorders
-more peer rejection
-more antisocial personality disorder in parents
-more neuropsych/bio dysfunction
-more genetic influence
-more comorbid disorders
-more impaired in their functioning
-decreased adaptive functioning
-more likely to have CD behavior/disorder persist over time
-more use and/or referal for mental health services.

Front 12

12. What issues may deserve further consideration in future DSM versions of conduct problems
(ODD and/or CD), and why??

Back 12

need ans

Front 13

13. In general, what variables does the empirical literature suggest is involved in "causing"
ADHD?? What other types of variables may play a role in "shaping" the specifics (in terms of
symptomatology, subtypes, severity, impairment, outcome, etc.)??

Back 13

-genetics = ADHD is inherited at 70-80%.

According to Waldman and Giser (2006), there are no shared environmnetal influences associated with the etiology of ADHD. There are some (10-40%) nonshared environmental influences.
-Other studies demonstrate that 60-70% people with ADHD have smaller right frontal lobes than normal people.
-Also, there is less metabolic functioning in frontal lobe (where executive functioning occurs
-Marital conflict and other psychosocial influences may shape symptoms but will not cause the disorder

Front 14

14. What conditions are often comorbid with ADHD (SECONDARY PROBLEMS), and how
might they (some of them) come to become "comorbid" with ADHD??

Back 14

Conditions that are often comorbid with ADHD include:
conduct problems, substance use/abuse, academic performance problems, emotional probs, social probs, developmental/medical problems.

How ODD/CD might become comorbid with ADHD:
-ADHD and ODD/CD have shared genetic influences.
-There are shared environmental influences that acct for covariation for the assoc betw ADHD & ODD/CD beyond genetics.
-In one study of boys with ADHD, it was disovered that some parenting behaviors were a specific, unique RF for developing later CD(specificallly, harsh and detached parenting).
-in a seperate study= mom's depression predicted the development of CD over time, pos parenting was protective


-deviant peer affiliation mediated relationship between child ADHD and many substance abuse problems.
-the level of ODD/CD sxn in adolescense moderated the relationship between ADHD and substance abuse in the sense that only in kids with high ODD/CD sxn was there the relation between ADHD and substance abuse

Emot problems:
The relationship between ADHD and depression is mediated by conduct disorder.

Front 15

15. What are the research findings regarding the outcome of ADHD for girls and boys (in
adolescence and adulthood) in various areas (ADHD symptoms, social, behavioral, emotional,
educational, occupational). And, what variables have been shown to be related to adolescent
and adult outcome of ADHD in the various areas above (predictors of outcome)?

Back 15

Outcomes:
-inattentive symptoms persist more than hyperactive/impulsive
-much higher continuation rates if we use parents as informant (instead of kid).
-The areaso of outcome include: ADHD sxn/disorders, conduct probs & substance abuse, emotional problems, social problems, educational attainment, employment functioning
-Conduct probs:
-40-50% of kids with ADHD will go on to dev CD
-ADHD adolescents tend to have higher rates of substance use
-Henshaw's girls: more substance use, externalizing probs. Hyperactive/impulsive probs and non-complicance leads to later substance abuse, externalizing.
-Barkeley's 13 yr follow up- More antisocial behavior in hyperactive kids. In terms of substance problems, both ADHD and conduct problems PREDICTED substance problems. SEverity of ADHD contributed to drug-related crime (when controlling for level of initial CD prob severity).
-ADHD kids are at risk for later antisocial behavior, substance use, and drug-related crime. If CD, they'll be even more at risk, but ADHD itself confers it's own independent level of risk.

Social probs:
Molina (06) ADHD boys had early initiation of sex activity, multiple sex parners, more casual sex in past yr, mor e parner pregnancies. There was indep and unique contribution of ADHD beyond that of child CD.

Emot probs:
ADHD kids are at risk for later depression by young adulthood
*ADHD's relationship with later depression is mediated by CD
ADHD predicts later anx & depression in girls
Also, the more hyperactive/impulsive and noncompliant someone was at T1, the more likely they were to have later internalizing problems and noncompliance.
ADhd kids have lower self esteem, more impaired in functioning, lower ed achieve. They also have probs socially.
-According to Barkley, severity of childhood ADHD and current ADHD led to fewer close friends and social probs

-The sxn that predicted academic probs among henshaw's girls was inattentive sxn

Employment:
ADHD have lower job status,more likely to be fired, lower work performance ratings, etc.

Front 16

16. What are the two "useful" subgroups (not DSM subtypes) of children with ADHD? How do
each of these two subgroups of ADHD children differ from children with ADHD and no
comorbid disorders (i.e., what are the distinguishing features of each of these 2 subgroups in
comparison to "pure" /noncomorbid ADHD kids)?

Back 16

NEED THE REST OF THIS ANSWER.
The two subgroups are:
1. ADHD with agression and/or CD
2. ADHD with Anxiety/Depression

For the ADHD/Depression kids:
-this grp will probably consist of more girls
-more likely to have parents with anx/depressive disorders
-do not respond well to ADHD meds, respond best to antidepressants
-respond well to behav mgmt tx
-fever externalizing probs than those with just ADHD, also lower levels of impulsivity

Front 17

17. What data/research findings do we have regarding the validity ofthe three subtypes of
ADHD as portrayed in the DSM-IV (i.e., what important variables do boys and girls diagnosed
with these various subtypes differ on in comparison to boys and girls diagnosed with various
other subtypes; how are the subtypes separate and distinct in terms of correlates, etiological
m. fluences, etc .?..?)

Back 17

ADHD Debate: The 3 subtypes (lA, HI, and C) have been found to have different
correlates, and differ on important variables, suggesting they are separate and distinct and
valid.
Prevalence rates (especially in clinic samples) vary across the 3 subtypes (C > IA > HI)
IA vs. C:
IA has later age of onset and later age of referral
IA has more Math LDs (even though some find NO differences on achievement and IQ)
IA may be more passive, shy, withdrawn, and have more internalizing problems
(although some studies find NO differences on internalizing DISORDERS, and
anxiety or depression symptoms)
IA fewer externalizing problems than C (and HI)
IA has more academic problems
C (and HI) has more behavior problems
C has more externalizing, aggressive, and delinquent behavior (parent and teacher report)
C has greater proportion of ODD and CD Disorders
C (and HI) more rejected by peers, more peer relationship problems
C more impaired, more comorbidity
Girls with ADHD more likely to have IA vs. other subtypes
Hinshaw's Girls: IA vs. C:
C more abuse histories
C is more overtly aggressive and has more behavior problems than IA (but no differ on
self- or parent-reported internalizing behavior)
C higher rates of ODD and CD (but both had high)
Staff reports show: 1) C more depression/anxiety, and 2) IA higher social withdrawal
IA is more socially isolated and less rejected by peers
(Note: No differences on Dep and Anx Disorders, or achievement or IQ measures)
HI: seems to be more related to behavior problems than academic problems; have mainly
externalizing behavior problems (less than C) and minimal internalizing problems

Front 18

18. What are some key questions and issues that really need to be addressed/clarified and/or dealt
with in our future DSM regarding ADHD and its "alleged" subtypes??

Back 18

need ans