PSYCH 251 UNDERSTANDING PSYCHOPATHOLOGY

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PSYCH 251 UNDERSTANDING PSYCHOPATHOLOGY

• Attention-Deficit/Hyperactivity Disorder (ADHD)

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OVERVIEW

• Defining Attention-Deficit/Hyperactivity Disorder
  (ADHD)
• Causal models for ADHD
• Treatment of ADHD
• Controversies

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BEHAVIOR DISORDERS OF CHILDHOOD

• EXTERNALIZING DISORDERS
• Attention-Deficit/Hyperactivity Disorder
• Oppositional-Defiant Disorder
• Conduct Disorder

• INTERNALIZING DISORDERS
• Anxiety Disorders of Childhood
• Depression

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Child Behavior Symptom Checklist Scales

• Withdrawn Internalizing
• Somatic Complaints
• Anxious/depressed
• Delinquent Externalizing
• Aggressive Behavior
• Social Problems
• Thought Problems
• Attention Problems

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ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
A. Either (1) or (2) (1) Six (or more) symptoms
of inattention (2) Six (or more) symptoms of
hyperactivity-impulsivity. (Symptoms have
persisted for at least 6 months to a degree
that is maladaptive and inconsistent with
developmental level).
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ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
A. Either (1) or (2) (1) Six (or more) symptoms
of inattention (2) Six (or more) symptoms of
hyperactivity-impulsivity. (Symptoms have
persisted for at least 6 months to a degree
that is maladaptive and inconsistent with
developmental level).
B. Some hyperactive-impulsive or inattentive
symptoms that caused impairment were present
before age 7 years.
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ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
A. Either (1) or (2) (1) Six (or more) symptoms
of inattention (2) Six (or more) symptoms of
hyperactivity-impulsivity. (Symptoms have
persisted for at least 6 months to a degree
that is maladaptive and inconsistent with
developmental level).
B. Some hyperactive-impulsive or inattentive
symptoms that caused impairment were present
before age 7 years.
C. Some impairment from the symptoms is present
in two or more settings.
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ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
A. Either (1) or (2) (1) Six (or more) symptoms
of inattention (2) Six (or more) symptoms of
hyperactivity-impulsivity. (Symptoms have
persisted for at least 6 months to a degree
that is maladaptive and inconsistent with
developmental level).
B. Some hyperactive-impulsive or inattentive
symptoms that caused impairment were present
before age 7 years.
C. Some impairment from the symptoms is present
in two or more settings.
D. There must be clear evidence of clinically
significant impairment in social, academic, or
vocational functioning.
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ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
A. Either (1) or (2) (1) Six (or more) symptoms
of inattention (2) Six (or more) symptoms of
hyperactivity-impulsivity. (Symptoms have
persisted for at least 6 months to a degree
that is maladaptive and inconsistent with
developmental level).
B. Some hyperactive-impulsive or inattentive
symptoms that caused impairment were present
before age 7 years.
C. Some impairment from the symptoms is present
in two or more settings.
D. There must be clear evidence of clinically
significant impairment in social, academic, or
vocational functioning.
E. Exclude Pervasive Developmental Disorder,
Schizophrenia, etc.
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ADHD

• Controversial diagnosis. Symptoms also occur in
  healthy children.
• For diagnosis, symptoms must occur in various
  settings, be reported by multiple informants, and
  interfere with the childs functioning.
• Inattention tends to persist throughout childhood
  and into adulthood hyperactivity and impulsivity
  tend to decrease with age.

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EPIDEMIOLOGY

• Estimated prevalence 3 - 5 of school-aged
  children.
• More common in boys than girls.
• Found in all cultures, but rates vary
  significantly.

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ADHD CAUSES

• Exact etiology is unknown.
• History minimal brain damage theory -- mixed
  evidence many brain-damaged children do not
  evidence hyperactivity if anything, they tend to
  be underactive.
• In the late 1970s inattention was seen as the
  core symptom. Attention-deficit disorder was
  introduced in 1980 (DSM III).

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ADHD CAUSES

• Familial aggregation
• Genetic factors
• Researchers are honing in on two genes
• a dopamine-receptor gene on chromosome 11
• the dopamine transporter gene on chromosome 5

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ADHD CAUSES

• Biological risk factors
• exposure to toxins (e.g., lead)
• episodes of oxygen deprivation during birth
• maternal smoking during pregnancy
• maternal drinking

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ADHD CAUSES

• Familial factors
• disruption (e.g., frequent moves divorce)
• parental antisocial behavior
• marital conflict
• intrusive, over-controlling parents --but cause
  or effect??
• when childs behavior improves as a result of
  treatment, parents have been found to become less
  controlling.

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STUDY EXAMPLE HOFSTRA, van der ENDE, VERHULST,
2002

• Parent reported behavior problems (measured in
  1983) of children ages 4-16
• Off-springs diagnostic status measured some 15
  years later (all children are now adults)
• what is the association between parent reported
  childhood problems and adult psychopathology?

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STUDY EXAMPLE HOFSTRA, van der ENDE, VERHULST,
2002

• Parent measure Child Behavior Checklist (CBCL)
  (Achenbach, 1991)
• Three general scores (cut-off82 percentile)
• CBCL Total Score
• Externalizing Score
• Internalizing Score
• Eight symptom scales (cut-off 95 percentile)

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MAIN INDEPENDENT (PREDICTOR) VARIABLE

• Deviance on the CBCL, as defined for the
  general scores and the symptom scale scores

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MAIN OUTCOMES

• Anxiety disorder
• Mood disorder
• Substance abuse/dependence
• Disruptive disorder
• Antisocial personality disorder
• Attention-Deficit disorder (with or without
  hyperactivity)

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• Do parent ratings on the CBCL predict risk for
  adult psychopathology?
• Are there gender differences in the continuity of
  childhood to adulthood psychopathology?
• What findings surprised you the most?
• What are the public health implications of this
  study?

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HOFFSTRA ET AL., MAIN RESULTS

• High levels of childhood behavioral and emotional
  problems predict adult psychopathology
• The CBCL Total Problem score as a general
  indicator of malfunctioning in children was
  associated with more diverse problems among women
  than men.

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HOFFSTRA ET AL., MAIN RESULTS

• Attention problems did not predict any adult
  disorders when analyses adjusted for other
  symptoms scales