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PSYCH Exam 2 Study Guide
Module 6: ADHD
Key Terms: executive functioning: A set of cognitive processes that allow an individual to produce meaningful, goal-directed behavior by selecting relevant thoughts and actions. working memory: The ability to keep something in mind while doing something else. responses suppression: The ability to interrupt a response during dynamic moment- to-moment behavior. set shifting/cognitive flexibility: The ability to shift one’s mental focus within a task or alternate between tasks. commission error: Pressing when you are not supposed to (in reference to Go/No Go Task) omission error: Failing to press when you are supposed to (in reference to Go/No Go Task) withdraw/reactive control system: Control’s individuals’ responses to potential threat or punishment, or novelty. Underlying neural structure: the limbic system. approach/reward system: Controls individual’s approach or willingness to approach possible incentive or reward. Underlying neural structure: dopaminergic system Review Questions:
1. What are the two key principles to consider when trying to understand ADHD symptoms?-
a. Dimensionality: Core symptoms of ADHD are best through of dimensionally
b. & Variability: Across children with ADHD in types of symptoms, severity
of symptoms, nature and degree of impairment
c. Meaning that symptoms present themselves in many ways and vary across children by type, severity and nature & degree of impairment.
i. Symptoms of adhd within a child can fluctuate across: time, persons,
tasks, situations, and settings
2. What are the two core symptom domains of ADHD?- a. Hyper-impulsive
i. fidget
ii. Difficulty staying seated
iii. run/climb (restless)
iv. Unable to play or engage in leisure activities quietly
b. Inattention.
i. Fails to pay attention to detail
ii. Difficulty sustaining attention
iii. Does not listen
iv. Does not follow through
v. Difficulty organizing
vi. \difficulty with tasks requiring sustained mental efforts
vii. Loses things easily distractibility
viii. Forgetful
3. What are the typical trajectories of symptoms of inattention and hyperactivity/impulsivity over time?- a. Hyperactivity impulsivity tends to go down with time.In study it dropped in late adolescence, but still compared to their peers they still displayed higher impulsivity i. Social expectation, neurobiological factors, manifestation b. In contrast, inattention increases from childhood to adolescence i. Might be more common/severe in adolescence compared to younger kids ii. So we should take into account age iii. More common symptom for adolescents compared to school aged children 4. What are the four functional systems implicated in ADHD? Know the components of each and which components have been found to be affected in individuals with ADHD. A) Attention: Alert/vigilance
a) Orienting: aligning attention to a source of information → teacher writing
on board → no for adhd
b) Selective/executive attention: ability to filter information and to
selectively focus and shift attention→ lecturing teacher, but kids
playing outside so its hard to focus → maybe for adhd
c) alert/vigilance: ability to stay “alert” → lecture drags on so the student
starts to lose attention or get distracted → yes for adhd
B) Cognitive control/executive function:
a) Set of cognitive processes that allow an individual to produce meaningful
goal directed behavior by selecting relevant thoughts and actions
b) COMPONENTS- Working memory, Response Suppression and Set shifting/ cognitive flexibility (defined above). C) Motivation and reinforcement: The approach/reward system & withdraw/reactive system.
a) Two basic motivational systems in brain
b) approach/reward system
i) Controls individuals approach or willingness to approach possible
incentive or reward
ii) Underlying neural structure: dopaminergic system (including
nucleus accumbens and ascendic limbic-frontal
dopaminergic networks)
iii) How to measure? Cognitive tasks with rewards/reinforcement
iv) Manipulate the types and frequency of reward/reinforcement (i.e
no reward, partial reward, continuous reward, reward with
points/token or money)
c) Withdraw or reactive control system
- CNS stimulant medication & Behavior therapy (Behavioral parent training, intensive peer intervention, teacher-delivered classroom behavioral intervention). Combined treatment is the recommended approach for children.
Treatment of ADHD in childhood
Treatment approaches w well established efficacy
a. CNS stimulant medication
b. Behavior therapy
i. Behavioral parent training
ii. Teacher delivered classroom behavioral intervention
iii. Intensive peer intervention (ex summer treatment program)
c. Combined treatment is the recommended approach for children
Treatment of ADHD in adolescence
Problems with stimulant medication
d. Despite increase in number of adolescents who are prescribed medication, up to
90% of adolescents refuse and subsequently desist stimulant medication by end of
high school
Problems with traditional behavioral therapy
e. Parents and adolescents with adhd often disengage from treatment due to high
parent adolescent conflict
f. Teacher delivered intervention: secondary school teachers often refuse to
implement treatment due to higher emphasis on students independence in
secondary school
Treatments for teens:
Cognitive enhancement training not effective
Behavior therapy produced greatest effects on functional
impairments Medication produced the greatest effects on adhd
symptoms
Practical implications:
g. Medication: not everyone can benefit from medication!
h. Adolescent direct behavior can be effective if: teaches teens skills to be applied
to daily life, provides regular monitoring and reinforcement of skills thru adult
support, promote teen autonomy and self efficacy by establishing a collaborative
relationship between parents and teens
8. What do we know about sex differences in ADHD? - More prevalent in boys 1. Girls tend to have more inattentive form 1. Aggression through relational rather than direct 2. More risk for peer rejection, suicide, cutting 1. 22.5% att. Suicide girls combined form ADHD 1. 8% inattentive 2. 6% natl. avg.
- 50% self harm
- 29% inattentive
- 19% natl. avg.
- Peer victimization is a moderator
- If we change outcome to attempted suicide, the relevant moderator is social preference.
Module 7: Conduct Disorders
Key Terms: antisocial behaviors: Age-inappropriate actions and attitudes of a child that violate family expectations, societal norms, and the personal or property rights of others. overt aggression: Physical aggression, argues, temper tantrums. covert aggression: Lying, stealing, substance abuse, truancy. physical vs relational aggression: Physical examples include- hitting, pushing, kicking etc… Relational examples include- telling other kids they don’t like them or won’t be their friend just to hurt them. proactive vs reactive aggression: Proactive- conscious and planned act, used for personal gain or egocentric motives… Reactive- An emotionally charged response to provocation or frustration. coercive parenting: A child misbehaves, the parent scolds or punishes the child, to which the child complains and the parent withdraws demand. This results in negative reinforcement of the behavior. Review Questions:
1. What are the developmental trajectories of overt and covert aggression? - Overt: peaks early & recedes after preschool. Overt: physical aggression, argues,
temper tantrums
Covert: rises till adolescence. Covert: lying, stealing, substance abuse, truancy
- H2: overt > covert → overt conduct problems are more attributable to genetics 2. What, if any, sex differences have researchers found related to anti-social behaviors/aggression?- Sex differences in prevelance (not told in lecture which is more prevelant but assuming boys)
a. More prevalent in males prior to adolescence ( 1. 4 : 1 )
b. Most prevalent in preschool through school-age
years-- Rarely extends past early adolescence
3. How are ODD and CD different? What are their core symptom domains? - ODD seems to be much more attitude heavy i.e, less dangerous behavior and more so a ‘defiant’ response.
7. What are some risk factors associated with conduct problems? Be able to identify risk factors from various domains (e.g., genetic, family environment, neighborhood, peer, etc...). a. Every domain has been identified, whether temperament, cognitive or whatever has been connected to elevated risk for conduct problems -Genetic: MAO-A, COMT -Prenatal & Perinatal: Low birth weight and birth complications, maternal smoking and substance use during pregnancy -Child Temperament: Negative emotionality, Impulsivity, Low prosociality -Child Cognitive Development: Verbal intelligence, Executive functions -Family & Parenting: Low SES, Family history of ASP, Physical & sexual abuse, Inconsistent discipline -Neighborhood: Poverty, Disorganization, Crime, Low collective efficacy -Peer: Peer rejection, Association w/ delinquent peers 8. How do peers contribute to the development of antisocial behaviors? - Peer rejection and association w/ delinquent peers are both risk factors for conduct problems. Antisocial behaviors interfere w/ positive relationships, peers may act as models and a source of reinforcement for antisocial behavior… etc etc… `Antisocial behaviors interferes with positive peer relationships peers may act as models and a source of reinforcement for antisocial behavior; As children develop friendship networks, support for antisocial behavior is established by providing both reinforcement and opportunity for such behavior. 9. Describe how peer coercion and how peer deviance training theories explain how peers contribute to development of anti-social behaviors and how they relate to overt vs covert conduct problems specifically. -Peer coercion: Coercive interactions between the child and peers. Relates to overt. EXs of coercive behavior-> teasing, threats, pushing, name calling etc. contends that interactions provide a training ground for the development of antisocial behavior; through an escape-conditioning sequence the child learns to use increasingly intense forms of noxious behavior to escape and avoid unwanted parental demands
Peer coercion: coercive interactions between the child and peers
Evident in early and middle childhoodnPeer’s coercive behaviors: teasing,
threats, negative gestures, name calling, pushing, hitting, scapegoating, accusing
of
wrongdoing
- Peer deviance training: discourse about, rehearsal and positive social evaluation of deviant acts. Relates to covert. EXs -> talks about and rehearsal of deviant behaviors (stealing, cheating, sex, authority defiance, etc) provides encouragement and instruction for how to engage in antisocial behaviors, which in turn promotes these behaviors as normative within the peer group Peer deviance training: discourse about, rehearsal and positive social evaluation of deviant acts
Evident in late childhood and adolescence Examples: talks about and rehearsal of deviant behaviors (stealing, cheating, aggression, swearing, authority defiance, sex, alcohol and tobacco)
- Myelination –increase myelination allows for improved integrity of white matter fiber tracts and efficiency of neural connectivity Anxiety, depressive behaviors can occur Lots of growth happening here, still developing thats why adolescents brain are more susceptible and have much more damaging effects Tree analogy Attacks: Frontal cortex: executive function, reasoning Hippocampus: memory Impacting many neurotransmitters and their processes (like GABA, Glutamate…) Cognitive deficits:
- Behavioral flexibility
- Context (learning from context)
- Attention
- learning/memory 3. What are some general trends we see in the progression of substance use? -Initiates in 7th to 10th grade and continues through early adulthood. -General trends include courses like “gateway” drugs. (alcohol->marijuana-
other illegal drugs)
a. Initiated in 7-10th grades, peaks in 18-25 years of age (emerging
adulthood), decreases in mid to late 20s (young adulthood)
b. Gateway drugs (alc and nicotine) → weed → other drugs
c. Abstinence → experimental use → early abuse → abuse → dependence
4. Be able to describe individual differences we see in substance use (early vs late-onset subtype, gender differences).
a. Possibly two subtypes in terms of onset
b. Early onset subtype (initiation before adolescence)
c. Late onset subtype )initiation in late adolescence or emerging adulthood)
d. Differences by gender, demands of adult roles (marriage, work, parenthood),
and parental history of substance abuse
5. Describe the three etiological models of alcohol use disorders described in lecture. -Deviance Proneness Pathways : Adolescents w/ genetic risks for alcohol use problems were more likely to associate w/ peers w/alcohol use problems.
Adolescents with genetic risks for alcohol use problems were more likely to
associate with peers with alcohol use problems and associated with deviant peers
mediated the effects of genetic risk on alcohol outcomes
- Adolescents with genetic risk for alcohol and tobacco use were more vulnerable
to influences from their closest friends in substance use than those with low
genetic risk
- Alcoholism acts as a moderator
- Stress and Negative Affect or Internalizing Pathways : Adolescents who experienced high levels of life stress were more likely to use alcohol and to escalate the quantity and frequency of use over time.
Adolescents who experience high levels of life stress were more likely to use
alcohol and to escalate the quantity and frequency of use over time
- In studies using intensive daily assessments researchers found higher rates of
drinking on days following elevated negative mood only in adolescents who
report more depressive symptoms and poorer parent emotion socialization
- After (but not before) the transition to high school adolescents who reported more
sadness than usual were also more likely to report same day drinking but only if
they had lower levels of parental social support
- Alcohol Effects Pathway: People who were exposed to alcohol at different points in their life have less adverse effects from alcohol.
Physiological reaction
a. Adult studies: After consumption of alc, adult males of alcoholic parents showed
greater cardiovascular stress response dampening benefits in anticipation of a
laboratory stressor. They experience less adverse effects of alcohol consumption
(less body sway, less perceived intoxication)
b. child/adolescent studies: on a task assessing implicit attitudes towards alcohol,
children who had begun to drink showed weaker automatic activation of negative
alcohol related associations than did those who were abstainers
6. What makes adolescence a vulnerable period for substance use? - Greater sensitivity to reward -Greater sensation seeking and risk taking -Greater sensitivity to social signals (e.g, peer evaluation and peer peer influences) -Gradual development of top-down cognitive control -Greater stress
a. Increased sensitivity to rewards
b. Increased sensation seeking and risk taking
c. Increased sensitivity to social signals (peer evaluation and influences)
d. Gradual development of top down cognitive control
7. What are some treatment options? What are treatment obstacles? - Options w/ empirical support include: Family therapy, Individual therapy, community Reinforcement approaches. -Treatment programs should develop procedures to minimize dropout and maximize motivation, compliance & completion, while encouraging and developing peer support.
- Adolescents with SUDs should receive specific treatment for their substance use
- Treatment approaches with empirical support
- Family therapy
- Individual therapy (CBT, CBT + motivational enhancement)
- Community reinforcement approaches (contingency contracting, vouchers)
c. May be associated with nightmares and physical symptoms
3. What are the core symptoms of Social Anxiety Disorder? -A marked and persistent fear of one or more social situations in which the person is exposed to possible scrutiny by others -The social situations almost always provoke fear or anxiety (may manifest as crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations) -Children may not recognize that the fear is excessive or unreasonable -The social situations are avoided or endured with intense fear or anxiety
a. Marked and persistent fear of one of more social situations in which the person is
exposed to possible scrutiny by others
b. Social situations almost always provoke fear or anxiety (crying, tantrums,
freezing, clinging, shrinking, or failing to speak in social situations)
c. Children may not recognize that the fear is excessive or unreasonable
d. Social situations are avoided or endured with intense fear or anxiety
4. What is the etiology of anxiety disorders? - Biological/ temperamental processes:
Temperament traits of shyness and behavioral inhibition are risk factors
for anxiety disorders
- Children high on this temperament style show:
- Long latency to approach or communicate with strangers
- A tendency to stay within close proximity of safety figures
- Signs of distress or withdrawal in face of novelty
- Restricted and inhibited social behaviors
- Behavioral learning processes : Aversive conditioning, Observational learning or modeling, verbal transmission of information.
- Socialization processes :
Two parenting styles have been linked to children's risks for anxiety disorders
- Overprotective, over controlling, or intrusive parenting → children don't
have opp to develop self regulatory skills and then are unable to cope w
anxiety
- Negative or critical parenting
- Relations between parenting and child anxiety could be bidirectional
- **Cognitive and information processing
- What sort of parenting styles have been linked to increased risk for anxiety disorders? -** Overprotective, over controlling or intrusive parenting -Negative or Critical Parenting 6. What are some treatments for anxiety disorders? -Skill based treatment or cognitive behavioral treatment. -Key components/skills of child treatment: psycho-education, affect recognition, cognitive restructuring, relaxation, gradual exposure, problem- solving and positive coping skills
-Key components/skills of parent or family intervention: Behavioral management skills, training parents in self-anxiety management and encouraging parents to model coping behaviors, family problem solving focusing on reducing family conflict
- Skill based treatment of CBT
- Key components:
- Psycho-education
- Affect recognition
- Cognitive restructuring
- Relaxation
- Gradual exposure
- Problem solving and positive coping skills
- Key components/skills of parent or family intervention
- Behavioral management skills
- Training parents in self-anxiety management and encouraging parents to
model coping behaviors
- Family problem solving focusing on reducing family conflict
- Assessment of ADHD must include evaluation of the childs functioning in key
developmental domains (interpersonal relationships, academic progress,
classroom, family)
- For treatment planning, contexts of symptoms and impact of symptoms on
functioning should be collected routinely
- DSM 5 diagnosis per se has little treatment utility
Developmental trajectories of ADHD symptoms from childhood to adolescence
- Longitudinal twin study, parent ratings of adhd symptoms collected at multiple ages
4 functional systems imapired in ADHD
1. Attention: alert/vigilance
a. Orienting: aligning attention to a source of information → teacher writing on
board → no for adhd
b. Selective/executive attention: ability to filter information and to selectively focus
and shift attention→ lecturing teacher, but kids playing outside so its hard to
focus → maybe for adhd
c. alert/vigilance: ability to stay “alert” → lecture drags on so the student starts to
lose attention or get distracted → yes for adhd
2. Cognitive control/executive functioning
a. Set of cognitive processes that allow an individual to produce meaningful goal
directed behavior by selecting relevant thoughts and actions
b. Multiple components
i. Working memory- the ability to keep something in mind while
doing something else
ii.ii.
3. Motivation and reinforcement
4. Temporal information processing
Executive function
- A set of cognitive processes that allow an individual to produce meaningful goal directed
behavior by selecting relevant thoughts and actions
- Components:
- Working memory: ability to keep something in mind while doing
something else→ affected in adhd yes especially with spatial wm
- Response suppression: ability to interrupt a response during dynamic moment to
moment behavior → yes affected
- Set shifting/cognitive flexibility: ability to shift one's mental focus within a task
or alternate between tasks → mixed evidence
- Neural basis: prefrontal cortex
The go/no-go task: a measure of response suppression and sustained attention
Two types of errors:
1. Commission error (pressing when not supposed to) → more difficulty with
response suppression
2. Omission error (failing to press when you are supposed to press)
Rule switching task: a measure of cognitive flexibility
Motivational systems:
- Two basic motivational systems in brain
- approach/reward system
- Controls individuals approach or willingness to approach possible incentive or
reward
- Underlying neural structure: dopaminergic system (including nucleus
accumbens and ascendic limbic-frontal dopaminergic networks)
- How to measure? Cognitive tasks with rewards/reinforcement
- Manipulate the types and frequency of reward/reinforcement (i.e no reward,
partial reward, continuous reward, reward with points/token or money)
- Withdraw or reactive control system
- Controls individuals responses to potential threat or punishment or novelty
- Underlying neural strcutre: limbic system (includiong amygdala, hippocampus
and their interconnections)
- Measure: go-no go tasks with rewards and punishments, card playing/door
opening, childrens responses to novel stimuli (i.e kagans work)
Temporal information processing
- Cerebellum: the internal clock
- Some symptoms/impairment of ADHD are associated with poor time estimation and poor
time reproduction
Two cognitive profiles in ADHD:
- A profile characterized by executive functioning deficits
- A profile characterized by slow and or variable reaction time
Three temperament/personality profiles in ADHD:
- A minority group with normative emotional functioning
- Group characterized by high surgency, extraversion and sensation seeking
- Group characterized by high neuroticism and negative affect
- Combined treatment is the recommended approach for children
Treatment of ADHD in adolescence
- Problems with stimulant medication
- Despite increase in number of adolescents who are prescribed medication, up to
90% of adolescents refuse and subsequently desist stimulant medication by end of
high school
- Problems with traditional behavioral therapy
- Parents and adolescents with adhd often disengage from treatment due to high
parent adolescent conflict
- Teacher delivered intervention: secondary school teachers often refuse to
implement treatment due to higher emphasis on students independence in
secondary school
Treatments for teens:
Cognitive enhancement training not effective
Behavior therapy produced greatest effects on functional
impairments Medication produced the greatest effects on adhd
symptoms
Practical implications:
- Medication: not everyone can benefit from medication!
- Adolescent direct behavior can be effective if: teaches teens skills to be applied to daily
life, provides regular monitoring and reinforcement of skills thru adult support,
promote teen autonomy and self efficacy by establishing a collaborative relationship
between parents and teens
Conduct problems/ antisocial behaviors:
- Age inappropriate actions and attitudes of a child that violate family expectations,
societal norms, and the personal or property rights of others
Two criteria of mental/physical
disorder Harm
- Social value component
- Cause functional impairment
- May be very culturally dependent, context dependent
Dysfunction
- Breakdown in a mechanism
- Interferes with natural function
Subtypes of CP: overt vs covert
Presentation:
- Overt: physical aggression, argues, temper tantrums
- Covert: lying, stealing, substance abuse, truancy
- H2: overt > covert → overt conduct problems are more attributable to genetics
- Developmental trajectories:
- Overt: peaks early, recedes after preschool
- Covert: rises till adolescence
Subtypes of aggression: physical vs relational
Presentation:
- Physical: hitting, pushing, or kicking
- Relational or social: tell other kids that they won't like them or be their friends just to hurt
them or get their own way
Sex differences in prevalence
- Physical aggression more prevalent in boys and relational more prevalent in girls
- Boys tend to have both
- Girls more likely to just have relational
Differential relations to children relational outcomes (peer liking, peer rejection,
reciprocated friendship)
Proactive aggression:
- Conscious and planned act, used for personakl gain or egocentric motives
- Also known as premeditated or instrumental aggression
- Eg used force to obtain money or things from others, yelled at other so that they would do
things for you, vandalized something for fun
Reactive aggression
- An emotionally charged response to provocations or frustration
- Also known as impuslive, affective aggression
- Become angry or mad when you dont get your way, damaged things because you
felt mad, hit others to defend yourself
DSM 5: Disruptive, impulse control and conduct disorders
- oppositional defiant disorder ODD
- Angry irritable mood
- Often loses temper
- Is often touchy or easily annoyed
- Often angry and resentful
- Argumentative defiant behavior
- Argues with authority figures or adults
