Annathur.Kalingan Wednesday, April 18, 2012
W201527095

TEST.III Learning Objectives & Review of Chapters.8, 9 &10.

Chapter.8. Schizophrenia Objective.1. Discuss the DSM-IV diagnostic criteria for schizophrenia, as well as the current criteria for brief psychotic disorder. What is the typical age of onset? What percent of people will develop this schizophrenia?

Following is the DSM-IV diagnostic criteria for schizophrenia. i. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated): 1. Delusions 2. Hallucinations 3. Disorganized speech (e.g., frequent derailment or incoherence) 4. Grossly disorganized or catatonic behavior. 5. Negative symptoms, (affective flattening, alogia, or avolition ii. For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work or school, interpersonal relations, or self-care is markedly below the level expected for the individual or achieved prior to the onset. iii. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). iv. Schizoaffective disorder and mood disorder with psychotic features have been ruled out. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. v. If there is a history of autistic disorder or another pervasive developmental disorder, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).
Schizophrenia is a disease that typically begins in early adulthood; between the ages of 15 and 25. Men tend to get develop schizophrenia slightly earlier than women; whereas most males become ill between 16 and 25 years old. Most females develop symptoms several years later, and the incidence in women is noticeably higher in women after age 30. The average age of onset is 18 in men and 25 in women. Schizophrenia onset is quite rare for people under 10 years of age, or over 40 years of age.

Within the United States, 1 to 2 percent of the population will develop schizophrenia at some time in their lives. Similarly, studies around the globe find that between 0.5 and 2 percent of the general population will develop from schizophrenia.

Objective.2. Define and describe delusions and hallucinations, as well as the three most common types of delusions and two common types of hallucinations:
Delusion is fixed beliefs with no basis in reality whereas hallucinations are perceptual experiences that are not real. The positive symptoms of schizophrenia, include delusions (ideas the individual believes are true but are certainly false), hallucinations (unreal perceptual experiences), thought, disturbances (incoherent thought and speech), and grossly disorganized or catatonic behavior. Objective.3. Describe the disorganized thought and speech in schizophrenia:
Disorganized schizophrenia is one of several types of schizophrenia, a chronic mental illness in which a person loses touch with reality (psychosis). Disorganized schizophrenia is marked by thoughts, speech and behavior that are inappropriate and don't make sense.
Disorganized schizophrenia is considered a more severe type of schizophrenia because people with this condition may be unable to carry out routine daily activities, such as bathing and meal preparation. It may be hard to understand what people with disorganized schizophrenia are saying. Also, frustration and agitation may cause them to lash out. Disorganized schizophrenia is sometimes known as hebephrenic schizophrenia.

Objective.4. Distinguish between Positive and Negative symptoms, as well as between prodromal and residual symptoms. Describe affective flattening, alogia and avolition:

The positive symptoms of schizophrenia, include delusions (ideas the individual believes are true but are certainly false), hallucinations (unreal perceptual experiences), thought, disturbances (incoherent thought and speech), and grossly disorganized or catatonic behavior.
The negative symptoms of schizophrenia include affective flattening, alogia (poverty of speech), and avolition (the inability to initiate and persist in goal-directed activities).
Affective flattening or blunted affect is a severe reduction or absence of affective (emotional) responses to the environment. In addition, people with schizophrenia often show inappropriate, affect, anhedonia, and impaired social skills. Prodromal and residual symptoms are mild, versions of the psychotic and negative symptoms that occur before and after episodes of acute symptoms. Objective.5. Identify the key features of four subtypes of schizophrenia: paranoid, disorganized, catatonic, and residual:
There are five subtypes of schizophrenia. People with the paranoid subtype have delusions and hallucinations with themes of persecution and grandiosity. This type of schizophrenia tends to begin later in life, and its episodes often are triggered by stress. People with this type of schizophrenia have a better prognosis than do people with other types. i. Paranoid schizophrenia: syndrome marked by delusions and hallucinations that involve themes of persecution and grandiosity ii. Disorganized schizophrenia: syndrome marked by incoherence in cognition, speech, and behavior as well as flat or inappropriate affect iii. Catatonic schizophrenia: type of schizophrenia in which people show a variety of motor behaviors and ways of speaking that suggest almost complete unresponsiveness to their environment. iv. Undifferentiated schizophrenia: diagnosis made when a person experiences schizophrenic symptoms, such as delusions and hallucinations, but does not meet criteria for paranoid, disorganized, or catatonic schizophrenia v. Residual schizophrenia: diagnosis made when a person has already experienced a single acute phase of schizophrenia but currently has milder and less debilitating symptoms.
Objective.6. Discuss the evidence for a genetic transmission of schizophrenia (family, adoption and twin studies.) What is the significance of enlarged ventricles, smaller prefrontal cortex, and damage to the developing brain from perinatal hypoxia and prenatal viral exposure?

Genetic Contributors to Schizophrenia

Family, twin, and adoption studies all indicate a genetic component to the transmission of schizophrenia. No single genetic abnormality accounts for this complex disorder (or set of disorders). Indeed, it may be that different genes are responsible for different symptoms of the disorder. One set of genes may contribute to the positive symptoms, and a different set of genes may contribute to the negative symptoms.

Adoption Studies:
A home with a parent with schizophrenia is likely to be a stressful environment. When a parent is psychotic, the child may be exposed to illogical thought, mood swings, and chaotic behavior. Even when the parent is not acutely psychotic, the residual negative symptoms of schizophrenia—flattening of affect, lack of motivation, and disorganization may impair the parent’s child-care skills.
Reports indicate genetics plays an important role in schizophrenia. Biological relatives of adoptees with schizophrenia were 10 times more likely to have a diagnosis of schizophrenia than were the biological relatives of adoptees who did not have schizophrenia. In contrast, the adoptive relatives of adoptees with schizophrenia showed no increased risk for the disorder.

In one of the largest adoption studies, Pekka Tienari (1991) tracked 155 offspring of mothers with schizophrenia and 185 children of mothers without schizophrenia; all the children had been given up for adoption early in life. Approximately 10 percent of the children whose biological mothers had schizophrenia developed schizophrenia or another psychotic disorder, compared to about 1 per cent of the children whose biological mothers did not have schizophrenia.

Family Studies:
Psychologist Irving Gottesman compiled more than 40 studies to determine the lifetime risk of developing schizophrenia. Children of two parents with schizophrenia and monozygotic (identical) twins of people with schizophrenia share the greatest number of genes with people with schizophrenia. These individuals also have the greatest risk of developing schizophrenia at some time in their lives. As the genetic similarity to a person with schizophrenia decreases, an individual’s risk of developing schizophrenia also decreases. One’s risk of developing schizophrenia decreases substantially as one’s genetic relationship to a person with schizophrenia becomes more distant.

Twin Studies:
Several twin studies of schizophrenia suggest that the concordance rate for monozygotic (identical) twins is 46 percent, while the concordance rate for dizygotic (fraternal) twins is 14 percent.
A study that assessed all twins born in Finland between 1940 and 1957 using statistical modeling estimated that 83 percent of the variation in schizophrenia is due to genetic factors (Cannon et al., 1998).Even when a person carries a genetic risk for schizophrenia, however, many other biological and environmental factors may influence whether and how he or she manifests the disorder. The classic illustration of this point is found in the Genain quadruplets, who shared the same genes and family environment while all developed schizophrenia, their specific symptoms, onset, course, and outcomes varied substantially. Recently, researchers have been investigating epigenetic factors that influence the expression of genes. DNA can be chemically modified by different environmental conditions, resulting in genes being turned on or off, thereby altering the development of cells, tissues, and organs. When MZ twins who were discordant for schizophrenia (i.e., one twin had schizophrenia but the other twin did not) were compared with MZ twins who both had schizophrenia, researchers found that the MZ twins discordant for schizophrenia showed numerous differences in the molecular structure of their DNA, particularly on genes regulating dopamine systems. In contrast, the MZ twins concordant for schizophrenia showed many fewer molecular differences in their DNA.

Structural and Functional Brain Abnormalities:

Researcher and development of technologies such as PET scans CAT scans, and MRI, enabled scientists to examine the structure and functioning of the brain. These new technologies have shown major structural and functional deficits in the brains of some people with schizophrenia. Most theorists think of it as a neurodevelopmental disorder, in which a variety of factors lead to abnormal development of the brain in the uterus and early in life.

Enlarged Ventricles:
The most consistent structural brain abnormality found in schizophrenia is enlarged ventricles. The ventricles are fluid-filled spaces in the brain. Enlarged ventricles suggest atrophy, or deterioration, in other brain tissue. People with schizophrenia with enlarged ventricles also show reductions in the prefrontal areas of the brain and an abnormal connection between the prefrontal cortex and the amygdala and hippocampus. However, enlarged ventricles might indicate structural deficits in other areas of the brain. Indeed, the different areas of the brain that can deteriorate to create enlarged ventricles might lead to different manifestations of schizophrenia.

Prefrontal Cortex and Other Key Areas:
Studies have shown abnormalities in the volume, density of neurons, and metabolic rate in several brain areas in people with schizophrenia, including the frontal cortex, temporal lobe, basal ganglia, and limbic area. The prefrontal cortex of the brain consistently is smaller and shows less activity in people with schizophrenia than in other people. In addition, people who are at risk for schizophrenia because of a family history but have not yet developed the disorder show abnormal prefrontal activity.

The prefrontal cortex connects to all other cortical regions, as well as to the limbic system, which is involved in emotion and cognition, and the basal ganglia, which is involved in motor movement. The prefrontal cortex is important in language, emotional expression, planning, and carrying out plans. Thus, it seems logical that a person with an unusually small or inactive prefrontal cortex would show the deficits in cognition, emotion, and social interactions seen with schizophrenia, such as difficulty holding conversations, appropriately responding to social situations, and carrying out tasks. The prefrontal cortex undergoes major development in the adolescent-to-young-adult years. Neuroimaging studies of individuals who developed schizophrenia in adolescence show significant structural changes across the cortex from ages 13 to 18, particularly in the prefrontal cortex.

The hippocampus is another brain area that consistently differs from the norm in people with schizophrenia. The hippocampus plays a critical role in the formation of long-term memories. In some studies, people with schizophrenia show abnormal hippocampal activation when they are doing tasks that require them to encode information for storage in their memory or to retrieve information from memory. Other studies show that people with schizophrenia have abnormalities in the volume and shape of their hippocampus and at the cellular level. Similar abnormalities in the hippocampus are found in first-degree relatives of people with schizophrenia.

Damage to the Developing Brain

There might be a number of causes, including specific genetic abnormalities, brain injury due to birth complications, head injury, viral infections, nutritional deficiencies, and deficiencies in cognitive stimulation. In some studies of MZ twins in which one twin has schizophrenia, only the twin with schizophrenia tends to show neuroanatomical abnormalities, even though both twins have identical genetic makeups. As noted earlier, epigenetic factors could contribute to these twin differences. In addition, damage to the developing brain could be due to other causes.

Birth Complications:
Serious prenatal and birth difficulties are more frequent in the histories of people with schizophrenia than in those of people without schizophrenia and may play a role in the development of neurological difficulties (Cannon et al., 2003). Individuals with schizophrenia who had delivery complications and who also have a familial risk for schizophrenia show greater enlargement of the ventricles and abnormalities in the hippocampus.

One type of birth complication that may be especially important in neurological development is perinatal hypoxia (oxygen deprivation at birth or in the few weeks before or after birth). As many as 30 percent of people with schizophrenia have a history of perinatal hypoxia. A prospective study of 9,236 people born in Philadelphia between 1959 and 1966 found that the odds of an adult diagnosis of schizophrenia increased in direct proportion to the degree of perinatal hypoxia. The authors of this study suggest that the effects of oxygen deprivation interact with a genetic vulnerability to schizophrenia, resulting in a person’s developing the disorder. Most people experiencing oxygen deprivation prenatally or at birth do not develop schizophrenia.

Prenatal Viral Exposure:
Epidemiological studies have shown high rates of schizophrenia among persons whose mothers were exposed to viral infections while pregnant. The link was particularly strong among people whose mothers were exposed during the second trimester of pregnancy. The second trimester is a crucial period for the development of the central nervous system of the fetus. Disruption in this phase of brain development could cause the major structural deficits found in the brains of some people with schizophrenia. Interestingly, people with schizophrenia are somewhat more likely to be born in the spring months than at other times of the year. Pregnant women may be more likely to contract influenza and other viruses at critical phases of fetal development if they are pregnant during the fall and winter.

Another study found that individuals whose mothers had been exposed to the herpes simplex virus while pregnant were more likely to have a psychotic disorder, most often schizophrenia. The authors of this study suggest that viral infections prompt a mother’s immune system to be more active, which can negatively impact the development of brain cells and dopamine systems in the fetus.

Objective.7. Why do neuropsychologists think dopamine is involved in this disorder?
Neuroimaging studies suggest the presence of more receptors for dopamine and higher levels of dopamine in some areas of the brain in people with schizophrenia than in people without the disorder.

Objective.8. Discuss the psychosocial factors associated with schizophrenia, including stress and relapse, and expressed emotion in the family:
Stressful events probably cannot cause schizophrenia in people who lack a vulnerability to the disorder, but they may trigger new episodes of psychosis in people with the disorder. Expressed emotion theorists argue that some families of people with schizophrenia are simultaneously overprotective and hostile and that this increases the risk for relapse. Objective.9. Discuss the drug therapies most commonly prescribed for schizophrenia. What was the serious side effect of the traditional antipsychotics? What is the advantage of the atypical antipsychotics?
Drugs known as the phenothiazines, introduced in the 1950s, brought relief to many people with schizophrenia. The phenothiazines reduce the positive symptoms of schizophrenia but often are not effective in reducing the negative symptoms. Major side effects include tardive dyskinesia, an irreversible neurological disorder characterized by involuntary movements of the tongue, face, mouth, or jaw.
Newer drugs, called atypical antipsychotics, seem to induce fewer side effects and are effective in treating both the positive symptoms and the negative symptoms of schizophrenia for many people. Objective.10. Discuss the cognitive, behavioral and family therapy interventions designed for people with schizophrenia: Cognitive theories suggest that some schizophrenic symptoms are attempts by the individual to understand and manage cognitive deficits. Psychological and social therapies focus on helping people with schizophrenia reduce stress, improve family interactions, learn social skills, and cope with the impact of the disorder on their lives. Comprehensive treatment programs combining drug therapy with an array of psychological and social therapies have been shown to reduce relapse significantly. These programs tend to be few and underfunded, however.

Chapter 9. Personality Disorders Objective.1. Define personality, personality trait, and personality disorder. What are the Big 5 Personality Factors? Why is personality disorders put on Axis II?
Personality is all the ways we have of acting, thinking, believing, and feeling that make each of us unique. Personality disorder is chronic pattern of maladaptive cognition, emotion, and behavior that begins by adolescence or early adulthood and continues into later adulthood. One of the leading theories of personality is the five-factor model, which posits that everyone’s personality is organized along five broad dimensions or factors of personality. These factors are often referred to as the Big 5 factors, negative emotionality, extraversion, openness to experience, agreeableness, & conscientiousness. Each factor has a number of facets. Objective.2. Identify the three clusters of personality disorders and the disorders in each cluster:

There are three clusters in personality disorders. i. Cluster A includes three disorders characterized by odd or eccentric behaviors and thinking: paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Each of these has some of the features of schizophrenia, but people diagnosed with these personality disorders are not out of touch with reality. Their behaviors simply are odd and often inappropriate. For example, they may be chronically suspicious of others or speak in odd ways that are difficult to understand.

ii. Cluster B includes four disorders characterized by dramatic, erratic, and emotional behavior and interpersonal relationships: antisocial personality disorder, histrionic personality disorder, borderline personality disorder, and narcissistic personality disorder. People diagnosed with these disorders tend to be manipulative, volatile, and uncaring in social relationships and prone to impulsive behaviors. They may behave in exaggerated ways or even attempt suicide to try to gain attention.

iii. Cluster C includes three disorders characterized by anxious and fearful emotions and chronic self-doubt: dependent personality disorder, avoidant personality disorder, and obsessive- compulsive personality disorder. People diagnosed with these dis orders have little self-confidence and difficulty in relationships.
Objective.3. Describe the key symptoms and characteristics of antisocial personality disorder. Which sex is more likely to exhibit it? What is the prevalence in the US?
Antisocial personality disorder (ASPD) is one of the most common personality disorders and is more common in men than in women. Potential contributors include a genetic predisposition; the effects of testosterone on fetal brain development; low levels of serotonin; low levels of arousibility; harsh, inconsistent parenting; and assumptions about the world that promote, aggressive responses. Objective.4. what is the evidence of biological theories that attempt to explain antisocial personality disorder? (Especially the impact of low arousibility and genetics.) What type of parenting and other environmental factors influence the development of this disorder?
According to Kenneth Dodge and Gregory Pettit this model, some people are born with neural, endocrine, and psychophysiological dispositions or into sociocultural contexts that put them at risk for antisocial behavior throughout their lifetime. Early symptoms of aggression and oppositional behavior in a child lead to, and interact with, harsh discipline and a lack of warmth from parents and conflicts with aggressive peers. These children are at risk for academic and social problems in school, which can motivate them to turn to deviant peer groups that encourage antisocial behavior. All along, such children learn that the world is hostile and that they must defend themselves rapidly and aggressively. They are prone to impulsive behaviors or reactions to others. These children enter adulthood with a long history of negative interactions with others, violent and impulsive outbursts, and alienation from mainstream society. All these factors feed on each other, perpetuating the cycle of antisocial behavior into adulthood. Objective.5. Apply questions 3 and 4 to Borderline Personality Disorder.
Borderline personality disorder is more common in women than in men. People with the disorder may have low levels of serotonin, which may lead to impulsive behaviors. There is little evidence that borderline personality disorder is transmitted genetically, but the family members of people with this disorder show high rates of mood disorders. Objective.6. Discuss why some of the personality disorders (such as antisocial personality disorder) are especially difficult to treat.
Because people with antisocial personality disorder tend to believe they do not need treatment. They may submit to therapy when forced to because of marital discord, work conflicts, or incarceration but they are prone to blaming others for their current situation rather than accepting responsibility for their actions. As a result, many clinicians do not hold much hope for effectively treating persons with this disorder through psychotherapy. Objective.7. Identify the differences between avoidant personality disorder, social phobia, and schizoid personality disorder.
Avoidant personality disorder is pervasive anxiety, sense of inadequacy, and fear of being criticized that lead to the avoidance of most social interactions with others and to restraint and nervousness in social interactions.
Social Phobia is extreme fear of being judged or embarrassed in front of people, causing the individual to avoid social situations.
Schizoid personality disorder is syndrome marked by a chronic lack of interest in and avoidance of interpersonal relationships as well as emotional coldness in interactions with others. Objective.8. Identify the similarities and differences between obsessive-compulsive disorder and obsessive-compulsive personality disorder.
The biggest difference between OCD and OCPD is the presence of true obsessions and compulsions. Obsessions and compulsions are not present in OCPD. For example, although both OCD and OCPD may involve being excessively engaged in tasks those require exquisite attention to detail (list-making)

Individuals with OCD: i. Individuals with OCD use these tasks to reduce anxiety caused by obsessional thoughts. For example. One with OCD might make a list over and over again to prevent the death of a loved one. In contrast, one who has OCPD might justify list-making as a good strategy to improve efficiency. ii. Individuals with OCD usually are distressed by having to carry out these tasks. In contrast, people with OCPD view activities such as excessive list making or organization of items around the home as necessary and even beneficial. iii. Individuals with OCD spend a much greater amount of time engaged in these tasks than people with OCPD. iv. Individuals with OCD will usually seek help for the psychological stress caused by having to carry out compulsions or the disturbing content or themes of obsessions. In contrast, people with OCPD, will usually seek treatment because of the conflict caused between self and others.
Severity of OCD symptoms often fluctuate over time, while OCPD is chronic in nature, with little change in personality style.

Chapter 10. Childhood Disorders Objective.1. Identify the symptoms of attention-deficit/hyperactivity disorder (ADHD), describe how it affects a child’s social and intellectual functioning, and discuss how it affects children as they enter adolescence and adulthood.
ADHD is characterized by inattentiveness, impulsivity, and hyperactivity. Children with ADHD do poorly in school and in peer relationships and are at increased risk for developing conduct, disorder. ADHD is more common in boys than in girls. Symptoms of the disorder are common in children and include being easily distracted, fidgeting, being unable to complete a single task and being easily bored. However, to receive a diagnosis of ADHD, a child must have at least six of nine symptoms of either hyperactivity or inattention, and the child's behavior must be causing problems in his or her life. The vast majority of children with ADHD have at least six symptoms in both categories.

Children with ADHD are two to three times more likely than children without the disorder to develop serious substance abuse problems in adolescence and adulthood. ADHD is a chronic condition that is likely to require treatment and monitoring over a lifetime. Inattention is problematic in childhood and remains so in adolescence and adulthood. Symptoms of hyperactivity and impulsivity, however, tend to diminish with age; they start becoming less problematic at about age 11 and continue to improve somewhat in the teen years. Nevertheless, because of the symptoms that continue to persist, children who take ADHD medication continue to be treated into their teen years; more than half still take the medication as adults.

Even though most kids don't outgrow ADHD, many do improve as they enter adolescence or learn to adapt to their condition. The further good news is that when the behaviors associated with ADHD are managed appropriately, people with the condition can learn to change them or compensate for them, develop personal strengths, and lead productive and successful lives.

At any age, the most effective way to manage the condition is a multimodal treatment that includes medication and behavioral therapy. Psychological counseling can also be beneficial, as a child or teen—or adult—deals with the low self-esteem and discouragement ADHD often causes.

Objective.2. Discuss the genetic, birth complication, neurological, and dietary contributors to ADHD: Biological factors that have been implicated in the development of ADHD include genetics, exposure to toxins prenatally and early in, childhood, and abnormalities in neurological functioning. In addition, many children with ADHD come from families marked by many disruptions; although it is not clear whether this is a cause or simply a correlate of ADHD. Objective.3. Describe the most effective drug therapies and psychosocial therapies for ADHD.
Treatments for ADHD usually involve stimulant drugs and behavior therapies designed to decrease children’s impulsivity and hyperactivity and help them control aggression. Objective.4. Discuss the symptoms and course of conduct disorder and oppositional defiant disorder, and how they differ by gender, rural versus urban, African-American versus European-American and socioeconomic class.

Conduct disorder has four main groupings:
A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, with the presence of three (or more) of the following in the past 12 months, with at least one in the past 6 months:
1. Aggressive conduct that causes or threatens physical harm to other people or animal A. Often bullies, threatens, or intimidates others, initiates physical fights. B. Used a weapon that can cause serious physical harm to others. C. Has been physically cruel to people and animals, D. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, robbery) E. Has forced someone into sexual activity
2. Non- aggressive conduct that causes property loss or damage A. Deliberately engaged in fire setting with the intention of causing serious damage B. Deliberately destroyed others' property (other than by fire setting)
3. Deceitfulness or theft A. Has broken into someone else's house, building, or car. B. Often lies to obtain goods or favors or to avoid obligations. C. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting) D. Seriously violated rules. E. Often stays out at night despite parental prohibitions, beginning before age 13 years. F. Has run away from home at least twice while living in home. G. Is often truant from school, beginning before age 13 years.
B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

Oppositional defiant disorder:

Oppositional defiant disorder: It is a syndrome of chronic misbehavior in childhood marked by belligerence, irritability, and defiance, although not to the extent found in a diagnosis of conduct disorder Symptoms of oppositional defiant disorder often begin during the toddler and preschool years. Some affected children seem to outgrow these behaviors by late childhood or early adolescence. Others, however, particularly those who tend to be aggressive, go on to develop conduct disorder in childhood and adolescence. Indeed, almost all children who develop conduct disorder during elementary school seem to have had symptoms of oppositional defiant disorder at a younger age.

Across cultures, boys are about three times more likely than girls to be diagnosed with conduct disorder or oppositional defiant disorder. Males are 10 to 15 times more likely than females to have life course- persistent antisocial behavior. Also, boys with conduct disorder tend to be more physically aggressive than girls with conduct disorder and thus more likely to draw attention.

Some researchers have suggested that antisocial behavior is not rarer in girls than in boys—it just looks different. Girls’ aggression is more likely to be indirect and verbal rather than physical. Girls appear to engage in relational aggression, such as excluding their peers, gossiping about them, and colluding with others to damage the social status of their targets However, girls and boys with conduct disorder are equally likely to engage in stealing, lying, and substance abuse. Long term studies of girls diagnosed with conduct disorder find that, as adolescents and adults, they also show high rates of depression and anxiety disorders, severe marital problems, criminal activity, and early, unplanned pregnancies.

Objective.5. Briefly describe the biological (genetic and neurological) and psychosocial contributors to conduct disorder and oppositional defiant disorder. What is the impact of a difficult temperament?

Genetics and neurological problems are implicated in the development of conduct disorder. In addition, children with conduct disorder tend to have parents who are harsh and inconsistent in their discipline practices and who model, aggressive, antisocial behavior. Psychologically, children with conduct disorder tend to process information in ways likely to lead to aggressive reactions to the behaviors of others.

Conduct disorder and oppositional defiant disorder are found more frequently in children in lower socioeconomic classes and in urban areas than in children in higher socioeconomic classes and in rural areas. A tendency toward antisocial behavior may run in families, and families whose members engage in antisocial behavior may experience downward social drift: The adults in these families cannot maintain good jobs, and the families’ socioeconomic status tends to decline. This tendency also may be due to differences in some environmental causes of antisocial behavior, such as exposure to toxins.

Objective.6. Briefly describes the biological and social factors that influence conduct disorder and oppositional defiant disorder.
Conduct disorder is characterized by extreme, antisocial behavior and the violation of other people’s rights and of social norms. Conduct, disorder is more common in boys than in girls and is highly stable across childhood and, adolescence. Adults who had conduct disorder as children are at increased risk for criminal, behavior and a host of problems in fitting into society. Objective.7. Identify the symptoms of separation anxiety disorder.

Symptoms of separation anxiety disorder may include: I. Repeated excessive anxiety about something bad happening or losing them. II. Heightened concern about either getting lost or being kidnapped; III. Repeated hesitancy or refusal to go to day care or school or to be alone or without loved ones or other adults who are important to the anxious child; IV. Persistent reluctance or refusal to go to sleep at nighttime without being physically close to adult loved ones;
V. Repeated nightmares about being separated from the people who are important to the sufferer and/or recurrent physical complaints, such as headaches or stomachaches, when separation either occurs or is expected.
To qualify for the diagnosis of separation anxiety disorder, a minimum of three of the above symptoms must persist for at least a month and cause significant stress or problems with school, social relationships, or some other area. Objective.8. Describe the criteria for reading and mathematics (learning) disorders. What percent of children are diagnosed with these disorders?

The DSM-IV-TR describes three specific learning disorders. They are diagnosed only when an individual’s performance on standardized tests of these skills is significantly below that expected for his or her age, schooling, and overall level of intelligence as indicated by intelligence tests.

Reading disorder involves deficits in the ability to read and usually is apparent by the fourth grade. It affects about 4 percent of children, more commonly boys In the DSM-5, reading disorder is likely to be renamed dyslexia.

Mathematics disorder includes problems in understanding mathematical terms, recognizing numerical symbols, clustering objects into groups, counting, and understanding mathematical principles. Although many people feel that they are not great at math, deficits in math skills severe enough to warrant this diagnosis occur in only about 1 percent of children. The disorder usually is apparent by about second or third grade. It probably will be renamed dyscalculia in the DSM-5. Objective.9. Discuss what is required for a diagnosis of mental retardation, the difference between organic and cultural-familial mental retardation, and how the symptoms of the disorder vary in severity from mild to moderate to severe to profound.

Mental retardation is defined as sub-average, intellectual functioning, as measured by an IQ score below 70 and deficits in adaptive behavioral functioning. There are four levels of mental retardation, ranging from mild to profound.

A number of biological factors are implicated in mental retardation, including i. Metabolic disorders (PKU, Tay-Sachs disease). ii. Chromosomal disorders (Down syndrome, fragile X, trisomy 13, and trisomy 18). iii. Prenatal exposure to rubella, herpes, syphilis, or drugs (alcohol). iv. Premature delivery; and head trauma (such as that arising from being shaken as an infant).

There is some evidence that intensive and comprehensive educational interventions, administered very early in a child's life, can help decrease the level of mental retardation. Objective.10. Discuss Down’s syndrome, Fragile X syndrome and FAS.

Several types of chromosomal disorders can lead to mental retardation. Children are born with 23 pairs of chromosomes. Twenty-two of these pairs are known as autosomes, and the twenty-third pair contains the sex chromosomes. One of the best-known causes of mental retardation is Down syndrome.

Down Syndrome which occurs when chromosome 21 is present in triplicate rather than in duplicate. (Also referred to as trisomy 21.) Down syndrome occurs in about 1 in every 800 children born in the United States. From childhood, almost all people with Down syndrome have mental retardation, although the level varies from mild to profound. Their ability to care for themselves, live somewhat independently, and hold a job depends on their level of retardation and the training and support they receive. Children with Down syndrome have a round, flat face and almond-shaped eyes; a small nose; slightly protruding lip and tongue; and short, square hands. They tend to be short in stature and somewhat obese. Many have congenital heart defects and gastrointestinal difficulties.

As adults, they seem to age more rapidly than normal, and their life expectancy is shorter than average. People with Down syndrome have abnormalities in the neurons in their brains that resemble those found in Alzheimer’s disease. Nearly all individuals with Down syndrome past age 40 develop the thinking and memory deficits of Alzheimer’s dementia and lose the ability to care for themselves.

Fragile X syndrome, another common cause of mental retardation, is caused when a tip of the X chromosome breaks off. This syndrome affects primarily males because they do not have a second, normal X chromosome to balance the mutation. The syndrome is characterized by severe to profound mental retardation, speech defects, and severe deficits in interpersonal interaction. Males with fragile X syndrome have large ears, a long face, and enlarged testes. Females with the syndrome tend to have less severe mental retardation. Two other chromosomal abnormalities that cause severe mental retardation and shortened life expectancy are trisomy 13 (chromosome 13 is present in triplicate) and trisomy 18 (chromosome 18 is present in triplicate).

The risk of having a child with Down syndrome or any other chromosomal abnormality increases with the age of the parents. This may be because the older a parent is; the more likely chromosomes are to have degenerated or to have been damaged by toxins.

Fetal alcohol syndrome that occurs when a mother abuses alcohol during pregnancy, causing the baby to have lowered IQ, increased risk for mental retardation, distractibility, and difficulties with learning from experience Objective.11. Discuss some of the effective interventions for mental retardation, including early intervention programs and mainstreaming.

Primary Prevention (preventing the occurrence retardation):Health promotion, Health education, especially for adolescent girls, Improvement of nutritional status in community Optimum health care facilities, Improvements in pre, peri and postnatal care, specific protection, universal iodization of salt, Rubella immunization for women before pregnancy, Folic acid administration in early pregnancy, Genetic counseling, Prenatal screening for congenital malformation and genetic disorders, Detection and care for high-risk pregnancies, Prevention of damage because of Rh incompatibility, Universal immunization for children,

Secondary Prevention (halting disease progression): Early diagnosis and treatment, Neonatal screening for treatable disorders, Intervention with “at risk” babies, early detection and intervention of developmental delay,

Tertiary Prevention (preventing complications and maximization of functions): Disability limitation and rehabilitation, stimulation, training and education, and vocational opportunities. Mainstreaming / integration, Support for families, Parental self-help groups

Objective.12. Describe the deficits exhibited by autistic children and those with Asperger’s disorder: Autism is characterized by significant interpersonal, communication, and behavioral deficits. Many children with autism score in the mental retardation range on IQ tests. Outcomes of autism vary widely, although the majority of people with autism must receive continual care, even as adults. The best predictors of a good outcome in autism are an IQ above 50 and language development before age 6.

The pervasive developmental disorders are characterized by severe and lasting impairment in several areas of development, including social interaction, communication with others, and everyday behaviors, interests, and activities. They include Asperger's disorder, Rett's disorder, childhood disintegrative disorder, and autism. Asperger’s disorder is a pervasive developmental disorder characterized by deficits in social skills and activities; similar to autism but does not include deficits in language or cognitive skills Objective.13. Discuss the genetic and biological causes of autism. Possible biological causes of autism include a genetic predisposition to cognitive impairment, central nervous system damage, prenatal complications, and neurotransmitter imbalances:
Autism is characterized by significant interpersonal, communication, and behavioral deficits. Many children with autism score in the mental retardation range on IQ tests. Outcomes of autism vary widely, although the majority of people with autism must receive continual care, even as adults. The best predictors of a good outcome in autism are an IQ above 50 and language development before age 6.

Possible biological causes of autism include a genetic predisposition to cognitive impairment, central nervous system damage, prenatal complications, and neurotransmitter imbalances. No single gene seems to cause autism; rather, abnormalities in several genes have been associated with autism and with the pervasive developmental disorders as a group. Neurological factors probably play a role in autism. The array of deficits seen in autism suggests disruption in the normal development and organization of the brain. In addition, approximately 30 percent of children with autism develop seizure disorders by adolescence, suggesting a severe neurological dysfunction.

Neuroimaging studies have suggested a variety of structural and functional deficits in the brains of individuals with autism, including in the cerebellum, the cerebrum, the amygdala, and possibly the hippocampus. A consistent finding is greater head and brain size in children with the disorder than in children without it. Objective.14. Understand the Chapter Integration
The field of developmental psychopathologists is concerned with the interdependence of biological, psychological, and social development in children, recognizing that disruptions in any one of these three systems send perturbations through the other systems. The interdependence of these systems probably is greater in children than in adults, because children are not mature enough to compartmentalize their troubles and are highly dependent on their caregivers and their environment.
An example of the interplay among biology, psychology, and the social environment comes from a study of adopted children. These results declare that there is clear evidence of the genetic inheritance of antisocial and hostile tendencies.

The researchers in this study, however, went further and looked at the parenting behaviors of the children’s adoptive parents. They found that the adoptive parents of the antisocial and hostile children were harsher and more critical in their parenting than were the adoptive parents of the children who were not antisocial and hostile.
It appeared that the antisocial and hostile children drew out harsh and critical behaviors from their adoptive parents. Harsh and critical parenting then exacerbated the children’s antisocial behaviors.

Thus, the children with biological parents who were antisocial or were substance abusers appeared to have a genetic predisposition to being antisocial and hostile. Their genes in effect created an environment of parenting practices by their adoptive parents that contributed to more antisocial behavior by the children.

These children were on a developmental trajectory in which their biology and their social environment were acting in synergy to lead them toward serious conduct disturbances.

This kind of synergy among biology, psychology, and the social environment is the rule, rather than the exception, in the development of psychopathology, particularly in children.