ADHD, ODD, & CD Disorders of childhood Nature of

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ADHD, ODD, CD

• Disorders of childhood

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Nature of Developmental Psychopathology An
Overview

• Normal vs. Abnormal Development
• Developmental Psychopathology
• Study of how disorders arise and change with time
• Disruption of early skills can affect later
  development
• Developmental Disorders
• Diagnosed first in infancy, childhood, or
  adolescence
• Attention deficit hyperactivity disorder (ADHD)
• Learning disorders
• Autism
• Mental retardation
• Conduct Disorder/Oppositional Defiant Disorder

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Attention Deficit HyperactivityDisorder (ADHD)
An Overview

• Nature of ADHD
• Central features Inattention, overactivity, and
  impulsivity
• Associated with numerous impairments
• Behavioral
• Cognitive
• Social and academic problems
• DSM-IV and DSM-IV-TR Symptom Types
• Inattentive type
• Hyperactive type
• Impulsive type

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ADHD Facts and Statistics

• Prevalence
• Occurs in 6 of school-aged children
• Symptoms are usually present around age 3 or 4
• 68 of children with ADHD have problems as adults
• Gender Differences
• Boys outnumber girls 4 to 1
• Cultural Factors
• Probability of ADHD diagnosis
• Greatest in the United States

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The Causes of ADHD Biological Contributions

• Genetic Contributions
• ADHD seems to run in families
• DRD4, DAT1, and DRD5 genes have been implicated
• Neurobiological Contributions
• Smaller brain volume
• Inactivity of the frontal cortex and basal
  ganglia
• Abnormal frontal lobe development and functioning
• Precise neurobiological mechanisms remain unclear
• The Role of Toxins
• No evidence that allergens and food additives are
  causes
• Maternal smoking increases risk

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The Causes of ADHD Psychosocial Contributions

• Psychosocial Factors
• Can influence the nature of ADHD
• ADHD children are often viewed negatively by
  others
• Constant negative feedback from peers and adults
• Peer rejection and resulting social isolation
• Such factors foster low self-esteem

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Biological Treatment of ADHD

• Goal of Biological Treatments
• To reduce impulsivity and hyperactivity
• To improve attention
• Stimulant Medications
• Reduce core symptoms in 70 of cases
• Examples include Ritalin, Dexedrine
• Other Medications With More Limited Efficacy
• Imipramine and Clonidine (antihypertensive)
• Effects of Medications
• Improve compliance in many children
• Decrease negative behaviors in many children
• Do not affect learning and academic performance
• Benefits are not lasting following
  discontinuation

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Behavioral and Combined Treatment of ADHD

• Behavioral Treatment
• Involve reinforcement programs
• To increase appropriate behaviors
• Decrease inappropriate behaviors
• May also involve parent training
• Combined Bio-Psycho-Social Treatments
• Are highly recommended
• Superior to medication or behavioral treatments
  alone

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CD/ODD

• Definitional issues
• Subtypes
• -verbal vs. physical
• -instrumental vs. hostile
• -proactive vs. reactive
• -direct vs. indirect/relational----indirect may
  pertain to girls more than boys
• -overt vs. covert
• -This leads to even more confusion in the
  fielddifferent definitions of ASB and different
  subtypes lead to a messy situation

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CD/ODD

• DSM-IV DEFINITIONAL CRITERIA
• - 4 subcategories of CD
• -socialized vs. undersocialized
• -aggressive vs. nonaggressive
• -Oppositional Disorder
• -variant of CD
• -intended to capture the early manifestations of
  antisocial behavior

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Developmental Norms

• -oppositional and defiant symptoms are common
  during the preschool years but then decline
• -those that do not exhibit the typical age
  related declines, ODD applies
• -CD not the norm
• -although increases in such behaviors are seen in
  early to middle adolescents with a steep increase
  for girls

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Prevalence

• -difficult to say, definitions have changed many
  times
• -epidemiological studies sparse and definitions
  differ
• -suspect reporting
• -retrospective age of onset a problem
• ODD
• -prevalence rates have ranged from 1 to more
  than 20 with median of 3
• CD
• -prevalence rates range from 1 to slightly over
  10
• -DSM-IV cites rates of 6-16 for males and 2-9
  for females

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Developmental Trajectories

• Developmental timing
• -ODD emerges 2-3 years earlier than CD symptoms
• -6 years is average for ODD and 9 for CD
  behaviors
• ODD pattern could serve as a developmental
  precursor to CD
• -ODD in middle childhood linked to CD in late
  childhood or early adolescence
• -over 90 of CD kids had ODD but the majority of
  kids with ODD do not develop CD
• -unclear what other diagnoses or impairments
  pertain to those with early ODD who do not
  progress to CD

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Developmental Trajectories (contd)

• Measures of antisocial behavior show considerable
  stability across the life span
• The composition of antisocial acts change over
  the years

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Comorbidity w/ ADHD

• There is an overlap in criteria and behavior
  associated with CD and ADHD
• Comorbidity is important because
• CD-ADHD is more severe
• Earlier onset of CD symptoms
• More likely to continue to display ASB into
  adulthood

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Comorbidity w/ Learning disabilities

• Link between aggressive/delinquent behavior and
  academic underachievement is well noted
• Complex developmental trajectory
• Early on, underachievement linked to ADHD
• Later, underachievement linked to ASB

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Comorbidity w/ Internalizing disorders

• Anxiety contradictory findings
• Depression Significant comorbidity
• Oppositional behavior during early childhood
  followed by internalizing difficulties is a
  significant predictor of substance abuse

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Risk Factors Etiology

• Genes
• Genetic effect differ by type of ASB
• Strongest for ADHD
• Moderate for overt ASB
• Relatively small for covert ASB
• Comorbidity between ADHD and CD is quite
  heritable as well

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Risk Factors Etiology

• Psychobiology
• Grays model
• Weak BIS
• Normal to Strong BAS
• Testosterone research inconsistent
• Cortisol may be implicated?

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Risk Factors Etiologies

• Family factors
• Intergenerational linkages of ASB
• Parental psychopathology
• Paternal ASPD
• Parental Substance Abuse
• Maternal Histrionic PD
• Parents aggression
• Maternal depression
• Family characteristics
• Low levels of parental involvement
• Poor supervision
• Harsh and inconsistent discipline

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The big question

• Antisocial behavior is prevalent. However, a
  majority of individuals stop exhibiting
  antisocial behavior when they reach adulthood.
  What factors might differentiate between those
  who persist and those who do not?

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Pattersons Idea

• Parent-child interactions and training by deviant
  peers

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Moffitt Lynams idea

• Comorbidity between disorders leads to persistent
  antisocial behavior

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Kochanska idea

• Different types of discipline lead children who
  are high and low on temperament fear to develop
  conscience