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Wk6 - ADHD and Conduct Disorders (Attention-Deficit / Hyperactivity…
Wk6 - ADHD and Conduct Disorders
Externalising VS. Internalising Disorders
Externalising
(outwards / behavioural)
Internalising
(inwards / emotional)
Attention-Deficit / Hyperactivity Disorder
DSM-5 Symptoms
Inattention
Hyperactivity/Impulsivity
(6 or more symptoms + 6 months)
Onset during Early Developmental
ADHD Presentation Subtypes
Predominantly
inattentive
presentation
Predominantly
hyperactive-impulsive
presentation
Combined
presentation
ADHD Course
Most common (50% referrals)
Identified as early as age 4 -5
High levels of activity, disrupted sleep patterns, slow toilet training
Symptoms = diminish with maturation (or not)
Increased Risks of car accidents, speeding tickets, unplanned pregnancy, STDs
ADHD Prevalence
3 - 7% (better diagnostic criteria - consistent results)
Boys > girls (2:5)
Comorbidities and Associated Problems
Externalising Disorders
Learning Disorders / substance abuse
CD / ODD / Bipolar disorders
Internalising Disorders
Depression / Anxiety
Academic / occupational problems
Unpopular / interpersonal problems (social errors - difficulties implementing social rules due to impulsivity)
DSM-5 Requirements
Symptoms interfere > QOL / functioning
Individual levels of development might be considered for some
Behavioural / Psychological Dysfunction
Biological Theories of ADHD
Neurological / psychological abnormalities
Impairment of executive tasks
Frontal lobes = under-responsive / small / reduced blood flow
Small corpus callosum / Reduced basal ganglia activity
Dopamine system involvement
Environmental Toxins
(smoking / alcohol abuse)
Genetic Transmission
(50% chance)
Interventions (therapy)
Psychological Intervention
(Reward/penalise behaviour + parent training / Token-based systems / enhance behavioural profiles supported)
Combined Programs
(Jensen et al. - Control, med, behv, both = medication and combination better but reduced 50% follow up)
Biological Intervention
(short-term effects, no long-term effects for secondary symptoms / side effects)
Aggression
(Normal) Proactive and Reactive Aggression
Reactive (spur of the moment)
ANS Arousal
Frustration-aggression Model
Reaction to threat (early onset)
Emotion Dysregulation
Harsh / inconsistent parenting
Proactive (planned for reward)
Acts of domination / coercion (bullying) are reward-driven
Harsh + maladaptive parenting style (expressed hostility)
Later onset, less arousal
Planned / premeditated for reward
Family Risk Factors in Early Development
Caregiver Depression / Stress
Low SES, caregiver sensitivity, quality of care-giving
Avoidant attachment
(Normal) Prosocial + Aggressive Behaviours
Instrumental Aggression
(No intent to harm / benefits)
Interpersonal / Hostile Aggression
(intent to purposefully hurt)
Prosocial
(intent to help / empathy)
Moderation to Aggression
Maternal Practices
High Risk for Stable Aggression
Maternal Rejection
Child Characteristics: Low inhibition, fearlessness, anger
Maternal Depression
Normal Aggression and Development
Aggression may be innate
Self-regulation + self-control (negative impulse)
Socialisation (internalisation)
Cognition (delay)
Emotional Regulation (inhibited)
Nature of aggressive behaviour changes with developmental period
Conduct Disorder
Subtypes
Childhood Onset
Adult-Onset
Prevalence
Definition
(persistent pattern - violate rights of others / norms / rules)
Destruction of Propety
Deceitfulness or Theft
Aggression to people or animals
Serious Rule Violations
Interventions
Oppositional-Defiant Disorder
Differentiating Externalising Disorders