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Psychology Notes > Abnormal Psychology (2nd year) Notes

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Condensed notes of personality disorders, BPD, psychopathy and externalising disorders

ADHD

CHARACTERISTICS
Hyperactivity
Impulsivity
Inattention
 starts in childhood
Lower intelligence  usually 7-15 IQ points below average
Mild, moderate or severe severity 3 subtypes in DSM-IV-TR:

1. Inattentive (IA)

2. Hyperactive-impulsive (HI)

3. Combined (C)

PREVALENCE RATE - GENDER DIFFERENCES
More frequently among preadolescent boys  6-9x more prevalent in boys than girlsx more prevalent in boys than girls
Planczyk et al., 2007; 2014: a Neurodevelopmental disorder affecting 5-7% of children worldwide
Alloway et al., 2010: in the UK 8% are diagnosed with ADHD

4.4% adults

NEUROCOGNITIVE DEFICITS
Executive function deficits in inhibition, WM, cognitive flexibility and planning
Biederman et al., 2004: ADHD  EF deficits  poor academic achievement
Shaw et al., 2007:
Both control and ADHD groups = similar development process of cortical thickness
ADHD group = delay in reaching this developmental marker
Reduced activity in: PFC
Reduced volume of cerebellum and basal ganglia

HERITABILITY/GENETIC LINK
76% heritability - twin meta-analysis 52% genetic, 48% environmental
Biederman et al., 2012: rates of ADHD are sig higher between biological relatives compared with adoptive relatives Condensed notes of personality disorders, BPD, psychopathy and externalising disorders
Target genes implicated:
 Dopamine receptors - DRD4, DRD5
 Dopamine transporters - DAT1
 Serotonin receptors - 5HTTPLR
Other genes involved in noradrenergic and nicotinergic pathways

ENVIRONMENTAL FACTORS

1. Breslau & Chilcoat, 2000:
Low birth weight
 but accounted for by maternal smoking
 higher ADHD in urban than suburban areas

2. Tobacco in utero  may damage dopaminergic system

3. Prenatal alcohol consumption

4. Family pathology  parental personality passes to children

5. Lead exposure  low IQ and hyper-active traits

TREATMENTS
Medications = controversial
Behaviour therapy, particular cognitive = great deal of promise in modifying the behaviour of children with hyperactivity
Drugs = only reduce symptoms and LT effects unknown
Ritalin  lowers aggression
BUT decreases blood flow to brain and similar to cocaine
Family therapy  highly successful
Positive reinforcement and structuring learning materials/tasks to maximise feedback and success  more successful for lower levels of ADHD

Multimodal treatment of ADHD (MTA) study: Jensen et al., 2001:
 Slightly better than medication alone
 Improved social skills whereas medication alone did not
 No difference in groups at 3 year follow-up
 Stimulant medication more effective for some children than others Condensed notes of personality disorders, BPD, psychopathy and externalising disorders

CD

CHARACTERISTICS
= a repetitive and persistent violation of rules and a disregard of others
Needs 3 or more of these in the past 12 months

1. Aggression to people and animals

2. Destruction of property

3. Deceitfulness or theft

4. Serious violations of rules
Kerr, 1997: social withdrawal = risk factor +vely predicting ASB

AGE OF ONSET - LIFE COURSE
Childhood-onset type: individuals show at least 1 symptoms charac of CD prior to aged 10
Unspecified onset: criteria for a diagnosis of CD are met, but there is not enough info available to determine whether the onset of the first symptom was before or after aged 10
Copeland et al., 2007: children who develop CD at an earlier age are much more likely to develop psychopathy or antisocial PD as adults than are adolescents who develop CD suddenly in adolescence
Moffitt (1993, 2006, 2007) 2 distinct CD types:

1. Life-course-persistent  10-15x more likely in M than F

2. Adolescence-limited

CU TRAITS
= construct of psychopathy
Low empathy/guilt, grandiose sense of self, low emotional, manipulative, shallow affect
 a particularly problematic group of children with more severe conduct problems
Lynam, 1997: Antisocial youth who show CU traits have been shown to exhibit a greater variety of severity of crimes than other youth with conduct problems
Lahey et al., 2016: CU traits + CD predicts reduced connectivity when viewing others being harmed 
disconnections between anterior cingulate and amygdala/insula  underlies empathy
Michalska et al., 2016: High CU and CD = lower hemodynamic responses in insula when viewing others being harmed

Pijper et al., 2015: -ve correlation between CU traits and empathy  particularly strong for CD M Condensed notes of personality disorders, BPD, psychopathy and externalising disorders

Urben et al., 2016:
Number of crimes explained by combo of onset age, CU traits and anger dysreg
High CU traits = little emotional arousal in response to distress in others or to punishment
Lahey et al., 2005: children with an early history of ODD (hostile defiant behaviour beginning at age 6,
followed by CD at age 9x more prevalent in boys than girls) are most likely to develop ASPD as adults

PREVALENCE RATE - GENDER DIFFERENCES
Lahey et al., 2006; Moffitt et al., 2001
Considerably more common in M
M outnumber F in CD onset by 3:1
Moffitt et al., 2001: magnitude of the sex diff diminishes around puberty relative to both late childhood and later adolescence

NEUROCOGNITIVE DEFICITS
Sterzer et a., 2007: the anterior cingulate and PFC are assoc with CD
Raine, 2002: lower levels of resting skin conductance and HR
Clark et al., 2000: those with ADHD performed worse on EF tasks whether they had comorbid CD/ODD or not

HERITABILITY/GENETIC LINK
Rhee & Wheldman, 2002: Meta-analysis of twin and adoption studies suggest 40-50% of antisocial behaviour is heritable
 Genetics a stronger influence when behaviours begin in childhood rather than adolescence
Caspi et al., 2002: Genetics and environment interact
 Abuse as a child PLUS low MAOA activity most likely to develop CD

ENVIRONMENTAL FACTORS
Moffitt, 1993: peer influence  affiliation with deviant peers
Poverty and socially disorganised environment
Family: children with CD  ineffective parenting, rejection, neglect
Children learn to avoid parental criticism by escalating negative behaviour  parents get angry  children mimic anger  parental attention reinforces rather than suppresses aggression Condensed notes of personality disorders, BPD, psychopathy and externalising disorders
Spiralling sequence:
Aggressive children are rejected by peers
Parents and teachers may also react negatively to aggressive behaviour  reject
Children become isolated and alienated
Children turn to deviant peer groups for companionship  imitate each other's antisocial behaviour
Moffitt Self-Perpetuating Cycle:
Genetic predisposition to low verbal intelligence/difficult temperament
Insecure attachment  parents cannot engage in good parenting
Falls behind in school  remedial programmes with similar others
Exposed to delinquent others  CD behaviour to gain acceptance

TREATMENTS
Society punishes rather than rehabilitates poor behaviour  seems to worsen rather than correct the behaviour
Cohesive Family Model: Patterson et al., 1998:
Focuses on changing the environment  BUT obtaining parental cooperation is hard
Sometimes children end up being moved out and fostered  new environment adds to feeling of rejection and worsens condition
Parental Management Training: Bass et al., 1992:
Teach parents to act as therapists to reward prosocial behaviour and modify environment that reinforced poor behaviours  focus on +ve behaviours not -ve
CBT:
Anger control training
Focuses on social cognitions and interpersonal skills
Taught to accept full responsibility for actions
Gardner, 2003: effective in reducing CD
Multisystemic Therapy (MST):
Combines family therapy and CBT
Focuses on environmental risk factors and individual risk factors
Home-based model of services delivery targeting 11-17y/o
Focuses on keeping families together
 Sig improvements for delinquency, family and peer factors - not for skills/cognitions
Most effective for severe conditions Condensed notes of personality disorders, BPD, psychopathy and externalising disorders
ODD

CHARACTERISTICS
= repetitive and persistent pattern of opposition, defiant, disobedient and disruptive behaviours towards authority figures persisting for at least 6 months
Lahey et al., 2000: virtually all cases of CD are preceded by ODD, but not all children with OD go on to develop CD within 3 years
A pattern of:
 Angry/irritable mood
 Argumentative/defiant behaviour
 Vindictiveness
Lasting at least 6 months
Mild, moderate or severe  symptoms present in 1, 2, or 3 settings

PREVALENCE RATE - GENDER DIFFERENCES
Nock et al., 2007: lifetime prevalence was relatively high: 11.2% for boys and 9x more prevalent in boys than girls.2% for girls
RISK FACTORS
Pijper et al., 2015:
-ve correlation between CU traits and empathy
Family discord, low SES, parental ASB

COMORBIDITY
CD and ANXIETY
Schoorl et al., 2016: CD+ANX  impaired cortisol response and recovery
Pliszka, 2006: 25% anxiety

CD and ASPD
40-50% of children with CD go on to develop ASPD as adults

CD and ODD
Pliszka, 2006: 45-84% Conduct disorders and oppositional defiant disorder

Substance abuse
CD and substance abuse  common BUT unclear whether it precedes or is concomitant with disorder

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