About 5% of the children and 2.5% of the adults are diagnosed with ADHD. There are several requirements for a diagnosis:
There are three subtypes:
Children with the inattentive presentation are often misdiagnosed and misunderstood. It is often misinterpreted as a lack of motivation. The children may be characterized by a sluggish information processing style and there are problems with focused or selective attention. These children are unable to filter essential from non-essential details. This lack of attention may result from information overload and the inability to selectively limit the focus of attention. They have poor performance on tests because of this problem with attention and their poor concept of time and time management.
Children with the hyperactive-impulsive presentation experience academic problems due to their impulsive nature. They emphasize speed over accuracy and approach tasks incorrectly because they do not wait for all instructions. They are at social risk due to their impatient nature and they often have poor social skills and difficulties making and maintaining friends. They often gravitate towards other rule-breaking children.
A difficult temperament (1), poor sleep patterns (2), excessive activity (3), irritability (4) and a difficulty soothing the child when they are upset (5) are risk factors in infancy for the development of ADHD. During toddlerhood, the child may demonstrate higher levels of underregulated behaviours and a lack of self-control may persist during the transition to preschool.
The symptom presentation of ADHD differs with age. Inattention symptoms are consistent over time but the hyperactive/impulsive symptoms decrease over time. There is a different ADHD symptom presentation by gender. Females typically have more inattentive symptoms and more internalizing problems while males have more hyperactive/impulsive symptoms. ADHD is more prevalent in males than in females but this may be due to the hyperactivity/impulsivity symptoms being more noticeable than the inattentive symptoms.
There are four biological features of ADHD:
The altered perception of time in ADHD is associated with reductions of dopamine in the basal ganglia. It may also be the result of dysfunction in the parietal lobe. Medication for ADHD (e.g. Ritalin) increases the number of catecholamines in the brain.
ADHD is very comorbid with other disorders (e.g. ODD). At least 62% has a co-occurring disorder and 34% has at least two co-occurring disorders. Symptoms of bipolar disorder and depression may be mistaken for ADHD. Children with bipolar disorder demonstrate rapid shifts of mood compared to lengthy moods for adults, making differential diagnosis very difficult.
For ADHD, different problems occur at different ages:
People with ADHD get in more accidents due to risk-taking behaviour. Children who receive medication for ADHD are less prone to substance abuse because they develop resilience and they do not self-medicate.
Barkley’s model of ADHD states that a child’s degree of success in behavioural inhibition is central to determining the outcome of working memory (1), self-regulation (2), internalization of speech (3) and reconstitution (4). Deficits in behavioural inhibition result in poor problem-solving strategies based on an inability to integrate and coordinate information generated by the four central processes. This model may explain the hyperattentive-impulsive presentation of ADHD.
According to this model, children with the hyperattentive-impulsive presentation have problems with sustained information and not with selective attention. Sustained attention consists of attention for effortful tasks and contingency-based attention (i.e. self-rewarding attention). Children have fewer problems with contingency-based attention in novel situations giving the false idea that these children are focused when they want to.
The dual pathway model of ADHD states that ADHD is explained by impairment in executive functioning and the motivational and reward system. Executive functions enable goal-oriented behaviour. Motivation does not refer to deliberate motivation.
Executive function is a control process of the brain and includes attention (1), inhibition (2), working memory (3), flexibility (4), planning (5), problem-solving (6), reasoning (7), initiation of action (8) and monitoring of action (9).
A child with executive functioning dysfunction is typically not annoyed by their own behaviour whereas it is frustrating for the teacher. There are several guidelines for helping a child with ADHD in the classroom with executive functioning problems:
ADHD is highly prevalent and has a different symptom presentation for everybody. The consequences of the disorder can be great and children with ADHD often show executive functioning problems. This, in turn, often causes academic problems. Parents and teachers can help alleviate some of the problems.
Children with ADHD often have deficits in motivation to perform due to dopaminergic system abnormalities. This means that they have (more) motivation to perform self-rewarding tasks with direct rewards (e.g. videogames) but not for other tasks. Children with these deficits need direct rewards (1), more rewards (2) and higher rewards (3). They take longer to learn new behaviour.
Typically developing children already have optimal performance with feedback only. However, the performance of children with ADHD improves with reward and there is more improvement with higher rewards but the performance of children with ADHD does not normalize, regardless of the reward. Children with ADHD have a decrease in performance over time but the performance over time normalizes when given a high reward. This implies that children with ADHD need more motivation, especially on long tasks.
There are several guidelines for helping a child with ADHD in the classroom with motivational problems:
Every school transition (e.g. other school; other grade) is a challenge for children with ADHD. However, parents and teachers can help by offering feasible tasks and rewards.
There may be a socially disabled subtype for children with ADHD symptoms and a discrepancy between social skills and cognitive ability. Oppositional defiant disorder (ODD) is very common in children with ADHD. It consists of a pattern of negative, hostile and rebellious behaviour. The prevalence of this is 3.3% but it often co-occurs with ADHD. 50% of the children with the combined subtype of ADHD have ODD and 25% of the inattentive type have ODD. There are several requirements for a diagnosis:
Common behaviour in ODD is a bad mood (1), arguing with adults (2), not obeying rules (3), aggression (4), destructive temper tantrums (5), irritating others on purpose (6), blaming others (7), being quickly irritated by others (8) and being vengeful (9). For children younger than five years, this behaviour needs to occur on most days. For children older than five years this behaviour needs to occur at least once a week.
What is normal naughty behaviour changes over the course of development. For example, temper tantrums are common in toddlerhood and naughty behaviour is common in preschool when the child’s goals are blocked (e.g. getting the ball). Problem behaviour is often seen in preschool years but is often unlearned over time.
Aggression in the preschool years is an important predictor of aggression in later life. There are three pathways to problem behaviour and delinquency:
The different pathways can overlap as it develops. There are several predictors of problem behaviour and these predictors are hereditary, rather than aggression itself.
The environment plays an important role in the development of aggression. There are several family characteristics in the case of child aggression:
There is often an attraction to peers with similar behaviour. If a child shows problem behaviour, this leads to many short-term relationships and many conflicts.
The learning theory states that problem behaviour is learned as a result of wrong instructions (1), wrong examples (2), endorsement of wrong behaviour (3) and through coercive interactions (4). Overlearned activities require very little active cognitive processing which makes it possible to do something else at the same time (e.g. driving and talking).
Coercive interactions consist of interactions where behaviour is enforced on one another and little attention is paid to prosocial behaviour. A coercive cycle can be parent-driven or child-driven. Coercive sequences are not pathological by themselves. A lot of the aversive events (e.g. attack) are positively reinforced by the victim (e.g. give up bicycle; cry), leading to an increase in the probability of future aversive events on the victim. Peers and siblings may be an important source of positive reinforcement, especially for physical aggression (e.g. hitting).
Coercion may be overlearned. The effects of reinforcement and punishment contingencies in family interaction sequences may be automatic. This means that this interaction is not mediated by thought or expectancies. Family therapy is very difficult because the coercion process is automatic.
It may be useful to bring the overlearned aspects of the coercion process in the open. This can be done by This can be done by providing clearly stated directives in a neutral affect and follow-up with positive reinforcement for cooperation and small negative sanctions for non-compliance.
The contingency theory states that everybody changes their behaviour to match the changes in contingencies one experiences in their social environment. The contingencies may operate outside of family members’ awareness or intention, meaning that they may result in increasing reliance on aversive behaviour as a means of influence and control. This may lead to extended conflict which escalates in intensity.
Negative reciprocity is more likely when one member of a family engages in coercive behaviour (e.g. when the mother engages in aversive behaviour, the child is more likely to also respond negatively). This leads to a sequence that increases coercion:
The presence of negative affect increases the risk and longer chains of aversive events are more likely to escalate in intensity. The negative reinforcement contingency that accompanied an aversive exchange is more powerful and resistant to extinction than positive reinforcement. This may shape aversive behaviour.
Infants may use negative contingencies to teach caregiving skills to family members (e.g. crying as an aversive behaviour). The differences in reactions of both the infant and the parents influence the risk for persistent involvement in coercive social processes (e.g. time spent crying before the caregiver picks up the infant). In most families, teaching the child to use words and positive behaviour gradually replaced coercion but it can persist to early childhood. Coercive behaviour peaks around the age of 3 (e.g. temper tantrums of toddlers).
The degree to which child coercive behaviours persist depends on the effectiveness of parents’ use of contingencies. The preschool period can be a period of growth in coercion, depending on parental skills and child temperament. There are three stages in the sequence of coercive behaviours:
Children who started aggressive and oppositional behaviour early in development were more at risk for police arrests and to become chronic offenders than late starters. Risk for police arrest increases as children move through the stages of coercion.
The macro-level of coercion describes the reactions people have when confronted by some form of antisocial behaviour (e.g. rejection of peer that shows antisocial behaviour). It is also associated with changes in the form of deviant behaviour that evolve from people’s reactions to antisocial behaviour.
As children move to stage three, they come into contact with a subgroup of peers who are even more extreme. They will combine elements of stage 1 with those of stage 2. There is a drop in positive parenting and monitoring as the family becomes increasingly coercive. These children drift into increasingly deviant environments through reinforcement.
The Parent Management Training-Oregon model (PMTO) is suitable for treatment and prevention of antisocial behaviour. It leads to more effective parenting (1), less child externalizing problems (2), less maternal depression (3), higher SES (4) and lower deviant peer association (5). The work-struggle hypothesis refers to the relationship between therapists and clients where the therapist suggests change and the client resists it.
The social interaction learning model (SIL) states that ongoing coercive behaviour is governed by its positive and negative reinforcement contingencies and not cognitive processes. This seems to be supported. A reduction in coercion is typically associated with a growth in positive parenting. Coercion and a lack of positive parenting contribute to growth in deviancy.
The information processing theories differentiate between reactive aggression and proactive aggression. According to these theories, reactive aggression is caused by rejection experiences. There is an aggressive experience (1), this leads to selective attention to threatening information (2), this leads to a negative interpretation of other people’s behaviour (3), this leads to anger (4), this leads to a difficulty in regulating the anger (5) which, in turn, again leads to an aggressive experience.
Proactive aggression is caused by observational learning and reinforcement of aggressive behaviour. The child has dominance and revenge goals (1), limited social skills (2) and an overestimation of approval of others on aggressive behaviour (3) and this leads to proactive aggression.
Aggression always has a reason. It is typically an expression of dissatisfaction or distress and can be the result of depression (1), anxiety (2), overestimation of situation (3), cognitive dissonance (4) or relationships with others (5). It is a coping style.
Psychoeducation can help families to communicate better. It consists of learning how to bear the feeling (1), communicate about emotions (2), learning to talk about difficult subjects when calm (3) and understanding the roots of the anger (4).
For the assessment of ADHD, a semi-structured interview is useful. It is important to use multiple informants (1), obtain information concerning other areas of diagnostic concern (e.g. depression) (2) and it may be useful to have a cognitive assessment to evaluate deficits in specific areas (3).
Treatment alternatives for ADHD depend on the comorbid features (1), symptoms (2) and the nature and extent of functional impairment (3). The interventions can be applied at home (1), at school (2) or in interactions with peers (3). Stimulant medication is more effective than behavioural therapy in alleviating core symptoms of the disorder but there are no long-term differences.
Anxious children with ADHD may benefit equally well from behaviour therapy compared to medication. Parent training can improve parenting skills (1), reduce parental stress (2), reduce core symptoms of ADHD (3) and reduce non-compliance (4).
Childhood: Clinical and School Psychology – Lecture 1 (UNIVERSITY OF AMSTERDAM)
A case formulation refers to a hypothesis about why the problem behaviour exists and how it is maintained. This should be based on the longevity of the problems (1), consistency of problematic behaviour across situational contexts (2) and family history (3). Problematic behaviour is characterized by the four d’s:
Deviance from the normThe duration should also be taken into account. Clinical decisions are often taken based on measures of intensity (1), duration (2) and frequency of the behaviour relative to the norm. To have a valid diagnosis, several things need to be taken into account:
It is essential to take the developmental stage of a child into account when assessing behaviour. According to Erikson, children develop through psychosocial stages with socioemotional tasks that must be mastered to allow for positive growth across the lifespan (e.g. trust vs. mistrust). Behavioural theories state that behaviour is shaped by associations (i.e. contingencies) resulting from positive and negative reinforcement.
There are three questions that need to be answered by the clinician after assessment:
The adaptation theory states that early attachment relationships have an impact throughout the lifespan. Triadic reciprocity refers to the dynamic system between the person, the environment and behaviour where all three influence each other.
Family systems theory states that the family is a system made up of subsystems (e.g. parent and child; parent and parent). The behaviours in a system are aimed at maintaining or changing boundaries, alignment and power. A family’s degree of dysfunction can be determined by boundaries that are poorly or inconsistently defined.
The DSM is a categorical diagnostic system. It makes use of clear-cut categories as this is needed for health care service (e.g. insurance). However, there are several problems with this:
Childhood: Clinical and School Psychology – Lecture 2 (UNIVERSITY OF AMSTERDAM)Fear refers to the emotional response to real or perceived immediate threat. Anxiety refers to the anticipation of future threat. Phobia refers to being fearful or anxious about or avoidant of a certain object or situation. There is no specific cognitive ideation.
There are four symptoms of anxiety:
Physiological symptomsThe purpose of anxiety is to alarm one of danger (1), prepare the body to act quickly (2) and keep distance from the danger (3). There is no strict boundary between typical and deviant anxiety. Therefore, the four d’s need to be evaluated when assessing anxiety.
What a child is afraid of changes with age. Children may be more afraid of animals due to their magical thinking. They may be afraid of the dark because of their inability to control it. At seven or eight years old children start to become more concerned with the future.
There is an increase in the prevalence of any anxiety disorders from the age of 11. There is a strong decline in separation anxiety disorder after the age of 10. For phobias, the prevalence can reach up to 16% in adolescence.
Children who suffer from anxiety disorders will be clinging (1), show physical complaints (2), have sleep problems (3), concentration problems (4), avoid certain situations (5), demonstrate a lot of ‘just in case’ behaviour (6), feel small (7), get angry (8), get easily upset (9), demonstrate perfectionism (10), stay home from school (11), lie (12) and alarm adults (13). There is comorbidity between ADHD and anxiety disorders.
Behavioural inhibition refers to inhibited behaviour. As an infant, there is high reactivity to stimuli (e.g. crying). In preschool, these children do not approach strangers (1), stare at strangers (2) and stays close to the mother (3). Modelling behaviour is stronger in the same-sex parent.
There are several risk factors for anxiety disorders:
Childhood: Clinical and School Psychology – Lecture 3 (UNIVERSITY OF AMSTERDAM)About 5% of the children and 2.5% of the adults are diagnosed with ADHD. There are several requirements for a diagnosis:
There are three subtypes:
Children with the inattentive presentation are often misdiagnosed and misunderstood. It is often misinterpreted as a lack of motivation. The children may be characterized by a sluggish information processing style and there are problems with focused or selective attention. These children are unable to filter essential from non-essential details. This lack of attention may result from information overload and the inability to selectively limit the focus of attention. They have poor performance on tests because of this problem with attention and their poor concept of time and time management.
Children with the hyperactive-impulsive presentation experience academic problems due to their impulsive nature. They emphasize speed over accuracy and approach tasks incorrectly because they do not wait for all instructions. They are at social risk due to their impatient nature and they often have poor social skills and difficulties making and maintaining friends. They often gravitate towards other rule-breaking children.
A difficult temperament (1), poor sleep patterns (2), excessive activity (3), irritability (4) and a difficulty soothing the child when they are upset (5) are risk factors in infancy for the development of ADHD. During toddlerhood, the child may demonstrate higher levels of underregulated behaviours and a lack of self-control may persist during the transition to preschool.
The symptom presentation of ADHD differs with age. Inattention symptoms are consistent over time but the hyperactive/impulsive symptoms decrease over time. There is
.....read more Childhood: Clinical and School Psychology – Lecture 4 (UNIVERSITY OF AMSTERDAM)Autism spectrum disorder (ASD) is a neurodevelopmental disorder with five criteria:
Symptoms of autism may not manifest themselves in early development if there is a mild version of the disorder. Most children with ASD will demonstrate difficulties in the key symptom clusters but the symptomatology and severity differ. The severity is based on support needed. This ranges from support to very substantial support.
In ASD, there is abnormal language development and several language difficulties are associated with ASD. The child with ASD:
There are several symptoms of Asperger’s syndrome:
While many people with Asperger’s syndrome see it as part of their identity, it was removed from the DSM-5 together with PDD-NOS (1), childhood disintegrative disorder (2) and autistic disorder (3). Asperger’s may not be severe enough to classify as part of the autistic spectrum. However, Asperger’s syndrome may be a separate category due to differences in language development.
.....read more Childhood: Clinical and School Psychology – Lecture 5 (UNIVERSITY OF AMSTERDAM)The WISC-IQ test measures the following:
It measures what somebody can do.The focus of an IQ test is on school-based skills (e.g. language; math; understanding; spatial skills; planning; problem-solving; logical skills) and it also measures acquired knowledge and skills. This means that an IQ test does not only measure potential but also current intelligence. It is important to assess whether deficits are the results of lack of opportunities (i.e. deprivation) or limitations in capacity.
There is not a perfect relationship between school performance and IQ as school performance may be lower than somebody’s IQ due to socio-emotional circumstances (e.g. being bullied) or other issues making school performance more problematic (e.g. dyslexia).
An IQ score is not a school advice in the Netherlands. The schools give an advice and CITO scores and IQ scores could change this advice. The traditional view of giftedness holds that a child with an IQ of 130 is gifted. The current view of giftedness holds that there needs to be high ability but not necessarily an IQ score of 130 or higher. Somebody is not only gifted if somebody has potential but also if this person shows gifted behaviour.
According to Renzulli, giftedness does not depend on a single criterion (e.g. IQ) but refers to the interaction between three clusters of traits;
This definition is applicable to any valuable area of performance (e.g. music; arts) and not just academics. People who are gifted score above average on each of the clusters but not necessarily in the superior range. Whether somebody is gifted depends on the needs and values of a culture.
Persistence in the accomplishment of ends (1), integration toward goals (2), self-confidence (3) and freedom from inferiority feelings (4) are personality factors that predict achievement among individuals with high intellect.
While intelligence on IQ test is relatively stable it does not say anything about development. Giftedness focuses on exceptional behaviour. Gifted children need educational opportunities that are normally not provided in regular instruction. However, this may be needed for all children but the outcomes differ depending on talent.
According to Gardner, there are multiple intelligences. This includes the following:
According to this view, giftedness includes a biopsychological potential to process information. This can be activated by the appropriate cultural setting (e.g. teachers should present lessons through a variety of methods, such as music).
Sternberg’s
.....read more Childhood: Clinical and School Psychology – Lecture 6 (UNIVERSITY OF AMSTERDAM)Multilingualism refers to speaking multiple languages. It is not just a technical task which only requires a cognitive dimension as it also has emotional, social and cultural significance. There are three dimensions for describing people’s associations with the languages they speak:
Simultaneous multilingualism (i.e. balanced bilingual) refers to learning the first and second language simultaneously. Both languages are learned in the home environment and the level of both languages is maximal depending on socioeconomic status and input. Successive multilingualism (i.e. functional bilingual) refers to learning the first language first and the second language after mastering the first one. The first language is learned in the home environment whereas the second language is learned at school or work. The level of the first language is maximal but the level of the second language varies. This multilingualism can be domain-specific (e.g. only reading; only speaking).
Lower order processes refer to the level of letter and word recognition. Higher-order processes refer to the comprehension of the content of text. Efficient lower-order processes allow to allocate optimal attention to the interpretation of meaning communicated in the text. Metacognitive skills in reading refer to the ability to use strategies to regulate the reading process.
When learning a language at home, exposure to the best language is essential. It appears as if the first language skill can predict second language learning early on in life. This could help with early diagnoses of reading and spelling problems of the second language. There are several theories as to how the first language influences learning the second:
In a structural model of languages, there are relations between skills in language one and language two. Lower
.....read more Childhood: Clinical and School Psychology – Lecture 7 (UNIVERSITY OF AMSTERDAM)
Specific learning disabilities are detrimental to one’s well-being. The repeated academic failure associated with this continues to haunt people for years after formal schooling.
A specific learning disability originally included a discrepancy-based definition. This included a discrepancy between IQ and achievement (e.g. high IQ, low reading achievement). However, the degree of discrepancy is arbitrary. This definition favours older children and children with a higher IQ. It is failure-based (e.g. waiting for children to show failure in academics).
The current definition is focused on identification with response to intervention (RTI). It includes achievement in key academic areas that is substantially below the age norm and in excess of sensory deficit (1), linguistic processes (2), attention (3) and memory (4). The prevalence rate is about 2% to 10%.
There are often social deficits in people with SLD but this may be because they get rejected and neglected by peers more often. People with SLD typically have low self-esteem and a poor self-esteem.
The DSM-5 definition of a specific learning disorder includes the following:
The DSM-5 uses a discrepancy definition but not an IQ-discrepancy definition. There are three specifiers for severity:
Positive psychology interventions (PPI) aim to enhance well-being by increasing positive affect, cognition and behaviour (e.g. developing hope; mastery of life). This includes teaching coping skills. This approach holds that dyslexics have unique strengths and there needs to be a focus on this. However, not all dyslexics have unique strengths and their problems need to be addressed. Positive behavioural interventions (PBI) are more common and focus on providing remedies for the problematic behaviours associated with a specific learning disorder. Changing one’s mindset can help in alleviating the negative aspects of a specific
.....read more
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