Hoorcolleges DPP

Week 37: Fundamentals I

Try to understand

So multifactoral model

DPP

Devopmental view of problem behaviors. Problem behavior in the youth and in their environment ; interaction.

General points

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Short video

DPP: Change over time. Broad and specific. Specific period of time or lifespan. DPP is also very interdisciplinayr; more coherent explainings; also allows for more methodological things.

Defining and identifying

Harmful to person self or other around.
doesn’t really fit to time perspective of development of child.
multivariate models. Age and situation/context you always need to ask yourself. Gender as well. Culture.
There are different views of what is appropriate and inappropriate.

DPP Perspective

Transactional view: between child and environment. Anxiety is adaptive or not depening on the situation or context for example.
continuity: behaviors build up on another. Discontinuity: not always predictive.

Changes: Typical and atypical

Baby, toddler, child, adolescents is often the division of years. Certain achievements of behaviors in particualr developmental phase. Stages where problems can occur, have to do with biological ho wit interplays with environment and psycholigy, so multidiscplinair.
object permanence, idea of self. Speech or languarge disorders.

Development tasks

Can be clustered in stages as well.

Behavior indicators of abnormal behaviors

Are various. They dont determine, they’re indicators.

Factors involved in judgements of (ab)normality

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How common are problems?

Epidemiology.

Impact of developmental level

Sometimes hard to see the onset, sometimes hard to see.

Impact of gender

Expressions also, because of expected behaviors/social norms.

Gender prevalence differences

Differences tend to decrease over time with externalizing problems, and increase with internalizing problems.

Historical influences

Early: Always focused on adults and idea that something external became internal.
19th: first time children pp. Also more etiology.

Historical influential theories

Freud: when difficulties with one phase, more difficulty wit hall other following phases.

Perspective and theory

Micro: social, close
macro: overarching

Models

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So what does DPP study?

Overarching, broad approach ot understand things

Causal factors & Mediators and Moderators & An example of mediators and moderators

Mediators: explain, it links 2 variables indirectly. Like practice between guitar and succesing in it.
Moderator: variable acts on relationship, like right DNA helps you to play better guitar and getting succes in it. making relationship stronger of weaker.

Pathways to development

Often more back-and-forth development. Temporarily maladaptation, like age-dependent or situation. Not always problemetical.

Continiuity of DPP symptomology

Heterotypic: like being anxious, but first about going to school and later about world problems.
cumulative: like living in poor environment where crime occurs

Pathways to DPP symptomology

Multifinality: multiple outcomes
equifinality.
still proabilities, not sure whether will happen.

Risk factors

Cumulations plays a role.
certain factors play more a role in onset, while other play more a role in persistence.

Resilience
you need to look at the trio of protective factors in combination. Multifactoral.

Characteristics of those who display resilience
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Temperament as either a riskor resilience factor
in terms of interacting with others, temperament can be a risk of resilience factor.

Nervous system development
CNS: brain en spinal cord.
PNS: rest.

Nervous system: brain structure
3. Makes translation of information between 2 hemispheres

Nevrous system: subcortical structures
how its processed. You have to see it in a complex chain.

Brain structure
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Neurotransmission
most important is looking at commucntionat of transmisson of information. Certain neurotransmitters, like cerotonine in depressions, are not transmitted wel. Biological tendency for depresion than. So plays role in DPP.

A simple way t oremember brain location
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Genetic studies
increasingly important.
Behavorial genetics: focus on gene-environment interactions.

Behavorial genetic research
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Gene-environment interplay as related to behavior
GxE: underlying sensitivity for environmental situations by genes
GE: not interacting, but the way you get acces to environmental situations.

Week 37: Fundamentals II

An ecological model of environmental influences

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Sociocultural context and DPP

Model of Bronfenbrenner
we extend from microsystem to macrosystem.

Nature vs. nurture debate

Interactions between genes and environment

Infant-caregiver Attachment

Multifactor outcomes, thus possible disorderde outcomes withe non-secure attachments.
Strange situation, child interacts with caretaker and researcher and then parent leaves.
Avoidant: not with caretaker and more stress.
resistant: not only distant from new things, but also mixture
disorganized: not clear what attachment, swings

Parenting

Interactive. Stimulate, but not deterministic.
Control on one side, as well as acceptance of the child. Hight acceptance and high control is authorative. Security of boundaries there. Independence and individuality in child then probably.
laisez-faire is another word for permissive parenting.
most parenting is authorative.

Major DPP Research Questions

Questions reflect different disciplines. Treatment, epidemiology

Research fundamentals

Quantative of qualatative decision before hypothesis. Which participants also plays a role. Representation of what population and can it be generalized to other populations? Different types of measurement; can be combination.

The research process

Start with theory. Can be based on previous research. Then get sample. Then data collection and data analysis.
There is a certain self-selection in getting a sample.

Measurement Reliability and Validity

Reliability: can you replicate it? rigorous.
Validity à
internal: rule out toher expalnatnions
External: can you generalize findings?
must find balance between internal and external validity, explain what balance you choose

Validity types

Face validity: when it makes sense
construct validity, etc.
Internal whether you think its correct; concept. External whether you can generalize to larger population.

Correlation studies

Cross-sectional only one point in time.

Cross-sectional vs. Longitudinal studies

Prospective much more formative, but more difficult (people fall out).
Cohort problem: cohort are gropus with norms. Cohort issues always play a role.

RCT’s

Double-blind: project leader knows, but the rest does not.
placebo and real medicin are independent variable for example.

RCT example

They kept getting better, risk becomes lesser when become older. Significantly different in cohort with this intervention.

Single-case experimental designs

Also study indiviuals
start with baseline, then apply intervention. You see how intervention affacts behavior. Here behavior increases and drops dramatically when stopped. If intervnetion is effective, behavior should increase over time.
See whether after intervention improvement is still there.

Multiple-baseline design across situations

You can layer different interventions over time, and have baselines varied. Layer different interventions over time.

Ethical issues in research of children
informed consent: they need to know what it fully is, also parents. However it does differ from country to country.
also how you conduct research, like anonymity.

Epidemiology
goal is ahving idea of what is happening in general, not specific numbers

Classifiction and diagnosis
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Classification approach to problem behaviors
ICD is from world health organization

Problems with the classification approach
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Empirical approach to problem behaviors
different kinds of factors
keep it specific those factors
those lines show that interrater  reliability is not that good, but thats also how people perceive it as well

Assessing problem behaviors
strengts also important for resilience

Assessment: interviews
semi-structured: you let interviewed say what he wants, but if not relevant, you let move on

Assessment: (self-)observation
sometimes its important to have controlled situations, then lab setting, want to understand in its context
observer drift: over time you see things other than other observers

Assessment: tests
you usually use a variety of tests

Interventions
treatment is more on invididual

Prevention
different types and targeted populations
selective, like certain schools.

Treatment
young children mostly play.
pharmacology discussed because of overperscription

Treatment principles (classical conditioning)
noise to albert can create fear. After some trials, rat becomes associated with noise and thus with fear.

Treatment principles (operant conditioning)
negative: removing the stimulus
Extinciton: ignoring behavior
generalization: when reinforcer works in different situations
shaping: making a behavior every time more complex

Treatment principles (observational learning)
learned behaviors become generalized.
only obervation can make you do things, you dont have to be reinforced

Week 38

Anxiety

Slide anxiety:
Three components. Tripartite model. Fear is about now, anxiety is about the future.

Slide anxiety is a part of normal development:
over time, it will diminish, you learn to deal with anxieties.
fears decline, while anxieties become more prevalent and complex

Slide normal development of anxiety
8-9 they better understand the world, thus also begin to fear things like death

Slide internalizers:
lot of mix, but definitely difference between anxiety and depression.

Slide development of pathological anxiety:
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Slide phobias:
you don’t have to know the figure, but it shows a bio-ecological model. There are always multiple factors playing a role in risk or protection. And how biology leads tot he way they learn from their environment.

Slide behavorial inhibiton:
some children stay freaked out after being scared.
independnt of how BI children learn from environment, they are more at risk duet o the biological factor.
video: difference in amygdala à inhibited

Slides behavorial theories of anxiety development:
3 pathways to phobia development.
classic is simulus to response while operant is response to behavior.

Slide operant conditioning processes:
partial reinforcemnt: only occurs occasionally thus reinforces behavior more.

Slide when has anxiety gone awry?
habituation: coming back to a relaxed state

Slide DSM-5 anxiety disorders:
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Slides separation anxiety disorder:
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Slides Generalized Anxiety disorder:
physiological differences between children and adults

Slide OK?!
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Slide panic attacks & Panic Disorder diagnostic criteria
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Slide phenomology
psychanalytic theory: expression of an underlying problem/unresolved conflict like a developmental task
behavorial theory: it is a issue, you can learn to deal with the symptom, the symptom is not more than the symptom itself
maybe the truth is somewhere in the middle, we try to combine those in developmental psychopathology
as there are also expected panic attacks, panic attacks are more common than panic disorder

Slide comorbidity in anxiety disorders
symptoms are often the same
negative affect as general risk factor
not causality! Just looking at how different factors play a role

Slide assessment
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Slide example SASC-R
 after high score on such a test, further assessing, mostly interview

Slide CBT
in vitro is thinking/imagining
in vivo is in real life experience
exposure in steps. Response prevention is for example making sure that one doesn’t run away, but you have to work well as every client is different
cognitive is changing the way you think (in video you see that he can see what aspect makes him able to deal differently)

Slide CBT dog phobia
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Depressive disorders

Slide take-home message
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Depression topics
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Slide History of Definition of Depression:
symptoms are different in children than in adults
DSM-III was break through

Slide DSM-5:
actually never draw conclusion already after 2 weeks
loss of interest is obvious symptom for depression
5. Everything take a lot of time, much effort costed
7. Its my fault; negativity

slide DSM-5 Depressive Disorders:
dysthymia over long period negativity but not so much as MDD. Feeling okay is stil bit feeling down
disruptive more for children and adolescence
when substance or medication is the cause of depression
due to medical condition is also one

Slide epidemiology:
numbers are consistent in the western world.
in adolescence, girls report more depression (internalizing disorders as a whole)

Slide developmental symptom course:
adolescense mood stil tend tob e agitated instead of depressed

Slide depression and causal processes:
both the idea of necessary and sufficient causes are not the deal with depression. Most are contibuting causes.
mediater could be that you are very sensitive

Slide etiology:
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Slide biological influences:
temperament, like NA.
showed by family and twin studies.
ita lso possible that environment plays a rol.
serotonin lower in females. But normally still not low enough.
neurotransmitters play a role in our moods. SSRI: re uptake inhibiterà keep more serotonin in brain.

Slide social-psychological influences:
larend helplesness: when attributing things to yourself
social relationships can reinforce depression by substance use or if they suffer too.

Slide Behavioral theories:
bowlby gave insight in how children experience loss

slide learned helplesness:
if you not have power over the situation, its your responsibility/fault.

Slide cognitive theories
you go from helpless to hopeless
 

Attirbutional style & Stress
environmental stressors are important as well

Slide negative cognitive triad:
you tend to devaluate yourself and the future and the world.
processing from negative view point

Negative social relationships:
peers, cousins, etc. can play important role
neative social interactions: if you get attention for being depressed, you show it more and then people stop coming to you and you feel more hopeless

slide Parental depression as a psychological risk factor
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Slide  unifying:
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Slide chorpita and barlow:
sense of control by events can work on BIS. Sense o control can also mediate between events and bis. Moderators make relationships stronger or weaker, while mediators have causality.

Slide depression assessment:
cognitive attributions: how you see yourself, the world and others

slide observation of behaviors:
whether and how emotions are expressed

slide Depression treatmens:
with younger children you can use parent in play as a model. Generalizing to home situation then.
behorial learning them tos eek things that pull them out

Slide film AT’s:
record, rationalize, replace

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Week 40

Eating disorders

Part 1: body image
Simple experiment show different people have different perceptions.
Is perception reality?
colour constancy: it depends on lighting,
visual illusions show importance of perception too.
so conclusions is that our brain is in charge! Not only percpetion of world around is is influenced by way we perceive, but also the way we see ourselves.

Part 2: AN an neuropsychology
not able to come up with an effective treatment.
humans are multisensory beings. We can also feel our body for example. Looking at youreself in picture and mirror. On picture, you only see your body. But in mirror, also acces to feelings of body. Weird that only focused on how they see their body. Why not involve all those different senses. In the past decade, there has been a shift in the people who study AN. More neuropsychology and neuroscience, more room for involving multiple senses.

Part 3: body in the brain
in neuropsucholgy and neuroscience lot of time spend in how we perceive our body and how brain is involved
semantics: kwowing your body parts, like having 5 fingers
it are MULTIPLE senses that contribute to the blueprint, internal model, of the body and its size in the brain.
lips are presented much bigger than the arm. For example, much larger part of homunculus for fingers than for arms. But we dont feel like the homonculus focuses. This is possible because we rescale via mental body representation.
the brain is constantly making calculations about the body. With almost every action, your brain will calculate whether and how you can do that action. For example, to get away a muschito, your brain need to feel where the muschito is, where your arm is relative tot his and how much strength you will need.
we dont have a body presentation to look in the mirror. A very natural body perception behavior is ‘bukken’ if there is something low above your head.
in terms of keeping your body safe, a false alarm is better than a miss. So better to see your body bigger than it is. So natural tendency to overestimate body size.

Part 4: body representation anorexia
tactile perceptionà AN overestimated the distance. Healthy controls seemed to underestimate.
in this task you have to ingrate information from skin to location on body. Brain projects information from skin to form distance estimate.
body scaled action: participants walked in straight line and crossed opening, rotating shoulders is green line in order to fit through opening. Very typical of healthy control behavior is that rotated shoulders most in narrowest openings. To keep body safe, always rotating a bit more than needed. As soon as door opening was 25% larger than they were, they started rotating. AN patients did this much quicker, already at average 40% with wider than their size.

Cognition and affect and visuals were affected, but also disturbed tactile perception and even motor planning & execution.

Part 5: prevention and treatment
rubber hand illusion to see if we can change the way AN see their body size: she only sees rubber hand. Experiment simultaneously strokes both hands. The brain decides i can see the touch, i can feel it, so it must be my own hand. In control condition, the experimenter doesn’t stroke simultaneously. After, they asked perception of the width of hand. Before the experiement, AN overestimate width size of own hand. After, they decreased to actual with of hand. For controls, there are no significatnly changes. So body illusion can give rise to changed perceptions. So also whole body illusion. After full body illlusions, an estimated body more accurate. Interestingly the improved body size estimation remains over time (for several hours).
however some downsides… not uniform over participants and body parts. We don’t know whether they also felt less fat. And this is not a therapeutic intervention, as exaclty the same results were found in control group. It could be because perception must be based on other sensories, like tactile.
however hoop training is a therapeutic intervention.
like the 7 shades of colours, when the reality is told to you, it won’t change your perception.
but again only visible information, so eating disorder has room to give reasons why its not true. Just seeing difference between how they feel their size and see it, its not that helpful. That why they wanted to create a treatment in which patients would literally feel their actual size. Because they get feedback on their size. Pregnant woman get his also, they bump into stuff as belly grows quickly. Hoop training will get AN patients actual direct feedback, as they feel stuff. Integrate different modalities of body perception in the hoop treatment. Giving the brain feedback by choosing a second hoop.
TAU=treatment as usual
significant improvements in tactile size estimation and better action planning
another aspect is prevention of body representation disturbances. Becasue they dont know whether healty persons also have not an accurate body representation, but just don’t place that much importance on it.
 

Young peope’s substance use

Part 1 How (ab)normal is adolescent substance use
why they engage in substance use? Then we need to know something about the changes adolescents encounter.
the maturity gap: between biological maturity and social maturity. Feeling mature and considered mature by society. Causes frustration. One of the reasons they get into substance use during adolescence.
in popular culture, much often referred to substance use. There is something to say why they want to engage in these behaviors.
however brain deficits due to alcohol (mis)use.

Part 2: How to explain international differences in adolescent substance use?
percentages of weekly drinkers. Top is girls, bottom is boys. So boys are more frequent drinkers. But also cross-national differences, mainly southern european countries, adolescents drink alcohol more frequently.
being druk at least 2 or more times. Then we see quite a different pattern. Southern countries are very light, and darker in more northern countries. So in some countries more frequent, in other countries more quantity.
comparing alcohol policies. Is it easy to get acces to alochol? What is the price of alchohol? The norms about drinking: frequency, drunkenness. Advertising.
measures with availability. Enforcement is important here.
price. 
drinking context. How do we want to deal with it in our society.
drinking cultures. Intoxication culture: alcohol use in these countries is often related to drunkennes. The goal of drinking alcohol is to get drunk. In these countries higher rates of drunkennes, binge drinking. Non-intoxication cultures. More positive expectations of alcohol use like relaxed feeling, fun, not the problems of getting sick or doings things you regret. Differences between girls and boys in alcohol use are smaller.
drinking cultures. Dutch adolescents thought drinking was cool, whether in france said getting drunk is childish. Can you change this culture by means of policy?
advertising.  The extent to which by law it is allowed to advertise for alcohol use.
API. Availibitly and price seemed effective. Also drinking context was positively related to alcohol behavior. With respect to alcohol advertising, we see a smaller effect. This measures are interrelated.

Part 3: Recent trends in the Netherlands
dramatic decline in young people’s age group? Related to implementation of specific national policies, but also a change in culture.
in the 90’s parents were less strict about alcohol use; the dominant idea in society and among parents is that alcohol is part of life for adults, you don’t give it to children and adolescents are in between, so they have to learn to deal with new autonomies, and alcohol might be one of them. Parents thought if you forbid it, they will do it anyway, and then in places where we dont want it. so better offer alcoholic drink at (the safe) home and learn how to deal with it.
in 90’s increase in alcohol use. Was not only because of liberal parents, also because adolescents had more money to spend and more fancy drinks got available. Netherlands in 2003 was alcohol use very high. In 2003 the most drunk kids in europe. Discussion starts about normalness of alcohol use of young people. In the years after that, some policies were implemented. 3 main messages.
in 2014 legal chance established in drinking age, also social norm campaign and parents were adressed too. We did see a change in parenting practices across time. The majority of parents would not allow their children to drink alcohol anymore.
we have to be careful in making conclusions. One other development was a huge increase in the influence of alcohol on brain development. Thus hard to say whether this policy was effective.

Part 4: International teen trends in substance use: what’s driving them?
international decline in tobacco use. With alcohol use, similar pattern. So it’s not a dutch thing. With cannabis use, again more or less the same pattern.
are these trends youth-specific? It seems really adolescent specific. So something specific is going on with young people.
how broad is this meta-trend? Some other indicators are also improving. Sexual career start is on later age. Juvenile crime and truency has inclined, and road safety has become better. What is going on with youth these days? Some say these generation is just less rebellious, some say they’re more consious about health. But other indicators are not consistent with that: obesity, nutrition and physical acitivites aren’t better, negative trend in condom use, decline in mental health. So we’re stuck with a puzzle: some indicators are imporivng, some are not.
trends & patterns. So other factors must also attribute.
that brings to question social context. In the last 20 years, the overlapping change was the one in innovation and technology.
question is whether smartphones and social have displaced substance use.
two contrasting theories. Displacement hypothesis: electronic media communication has replaced face to face time with friends, therefore there is less substance use.
the other, the stimulation hypothesis, is the other way around, youth who spend lot of time on social media, they’re just the social adolescents, and thus have also much face to face time with friends, thus use more substance.
if we look at studies, then positive relationship between time on phone, also quite some time with friends. Then would displacement hypothesis not explain it. another argument against displacement hypo: decline starts years before the smartphone was introduced. So probably the arrival of smartphone can not be a causal factor in the decline. But still research on the affect of social media use in explaingin the decline in substance use.
internationally we see quite similar trends, so it seems there’s something more. Social doesn’t seem to be it. and then? The truth is, there are just questions we just don’t know an answer yet. Lecturer now focuses on other factor: increase in schoolwork pressure.
 

Week 41

ODD & CD, a developmental perspective

Prosocial behavior: from 1,5-2 years. Individual differences. Relatively stable since 2 years. Conscience is also moral conscience like guilt. Friends become increasingly more important during adolescence. Ingroup en outgroup relations appear.
based on theoretical models (cognitive and affective underlying prosocial behavior), you would think prosocial behaviro would increase with age. However, results are mixed.
her study found that only one aspect of prosocial behavior, giving and sharing, increased in late adolescence. So not necessarilty that prosocial behavior increases and individual differences are important to take into account.

Antisocial behavior
agressions needs behavior caused to harm others.
reactive agression is in response to occasion.
proactive agression is planned.
overt agression includes harmful physical behavior and name calling.
covert agression includes more indirect means, like excluding someone.
bullying: negative interactions to hurt someone else, repeatedly. Most frequent during middele school years.
social information processing: how individuals perceive social informations. Hostile attent attributions are especially important. Social situations that are ambiguous, that children if they make these hostile attentions, than more reluctant for agressive behavior.
self regulation is more regulating your behavoiral reactions.

Four trajectories. In 4th no bullying and were not bullied. In first 2, bullying decreased or stayed stable. In 3rd, victimization decreased. So different trajectories of bullying and victimiazation.

Class 1 is not displaying agression. Only small sub group, class 2, showed proactive agression.
research also shows gender differences are important for prosocial as wel as antisocial behavior. Girls showed more proactive agression than boys.

Agressive & prosocial?
they’re not opposite behaviors. Developmental patterns might be related toe ach other.

ODD
negative behavior. Easily angered, no reponsibility own actions. Hostile against authority like parents.
most important aspects: negative behavior 6 months. 4 of 8 symptoms, displayed though interactions with not a sibling.
also some exclusion reasons. Severity shouls also be adressed, related to how many settings the symptoms are displaced.
boys more likely to receive ODD than girls, in childhood this is higher.
most often diagnosed by age of 8, but parents observe symptoms earlier. Often stable and higher severity related to higher stability.
often multiple disorders. Much comorbid of ODD and ADHD, which is especially problematic. Over pathway where minor agressions lead to more serious agression. Covert agression where misbehvaior leading to more concealing delinquent acts, like stealing. And authority path, like troubles with parents leading to more severe disobedience. ODD does increase risk of receiving CD.

CD
serious violations of norms and rules. Though CD is more severe of antisocial problem.
at least 3 symptoms of 15, visible in past 12 months (longer compared to ODD). If child above 18 years, make sure criteria of antisocial personality disorder can’t be met (exclusion disorder).
callous unemotional symptoms for example with limited prosocial emotions.
Boys again more likely to recieve. However, maybe criteria are more focused on physical than relational agression, could be why boys receive it more.
Moffit pathways. AL begins around puberty and ends around adulthood. While LP begins early and persists. Recent work should that negative long term outcome are especially pronounced in LCP.

APD
only diagnostible from age 18. Symptoms can be present earlier.

Developmental course of these different disorders, important to take into account.
ODD may lead to CD, which may lead to APD. However, see bullits.
behavoiral aspects of ODD symptoms more likely to be with children with ADHD before ODD occurs. IC stand for interpersonal callousness (CU-traits).

Summary.
For CD it’s important to see the age of onset, important for severity and stability. As well as whether the child has CU-traits.

Part 3 about models

Moffit model about etiology
individual and societal/environmental inputs. Risk for OD or CDD inherit from inputs. With increasing age, other people than parents give imput.

SIP
by crick and dodge. It states that SIP develops in several steps, and in each of this steps, children may have difficulties. Encoding, interpreting, formulating goals, generate problem solving strategies and evaluate the effective strategies, enact a response. Child’s mental state contibrutes to the way social information is processed. So this model may help explain individual difficulties, so within the child, within a situation.

Coercion model
focus on family dynamics and how they develop over time.  Parents yells at child, child makes bigger mess, parent gives up. If these processes continue to happen over time, then negative spiral of interactions where child engages in problem behavior and parent withdraws. Escalating over time.

Peer contagion model
in peer domain. Tendency to become friends with peers who have the same difficulties. Bidirectinoal relationship of peer contagion. Selection bias in selecting the same peers and bidirectional influence.

Developmental cascades model
all previous models were for 1 specific domain. This model however, can be used to intergrate risk factors from several domains. Each risk building on and expanding on previous risks, with early start. Child already displays some troubles when entering schools, this leads to school failure. Becasue of low parent monitoring, ability to associate with other deviant friends.

Summary part 3
different factors play a role. The model scan be used to explain how the risk factors play a role and how they interact with each other.

Part 4 interventions
cost-effective: costs of interventions return to benefits in the long term. Societal cost like mental health care, but also prison. Thus it’s important on starting on diagnosis.
multi-modal: different modalities included in interventions, for example child component like social and emotional dealing & more parent training. Parent training like triple P can be very effective. Child treatmentà in clinics its important to prevent peer contagion.

Richtlijn ernstige gedragsproblemen 8-12
what are maintaining factors? Several instruments to use. Interventions often combine multiple domains and components. It is new, but also helpful to give the family a say in which intervention to choose. ‘Minder boos en opstandig’ already combines child and family factors.
some factors needed to be taken into account, like intelligence. But also ethnicity or gender may be important to take into account.

Richtlijn ernstige gedragsproblemen 12-18
we might need other components that are helpful, cause different context and age. Multi systemic therapy and multi dynamic functional therapy seem to be very effective for older adolescents. With MST child, family and school system are involved, longer interventions for like 6 months, clinicans go to their environments.

Summary part 4
to select effective interventions, its important to early diagnose and focus on maintaining factors.
 

RCT: randomly assign children and parents to different groups. Follow symptoms over time and follow up. If significant difference between control and intervention group, then effective. But it’s expensive. in the past, they developed micro trial, they really looked at specific components of the intervention. Zooming in on what makes those interventions effective.
 

Trauma- and stress-related disorders

Child maltreatment
There are many definitions of child maltreatment.
different types.
parental characteristics: if you were abused, this is the behavior you know, so it could be your behavior to your child again.
stress is the main factor in family context risk factors
36% emotional neglect is main type of maltreatment, while this is the hardest one to see by professionals.

Child maltreatment in the Netherlands
several steps: strengthening parental support. Help public to recognize child maltreatment by campaign.
parents who are refugees often have ptss.

Meldcode
professionals have to be attentive of home violence and child abuse. It applies for many sectors.

Screening of child abuse
the only big difference was amount of children in a family.
results in comparison. In dutch study percentage of children of whom teachers perceived signals, was much higher. We see it in all seperate types of abuse.
in their study more risk factors have been observed. However, only 1.4% was in endangerment at the moment, while in Austria this was higher, while prevalence in Netherlands was also higher than the risk in the Netherlands. Lecturer thinks it has more to do met ‘terughoudendheid’ than really lower risk.
there is no clear relation between the risk factors, the estimation of whether the child runs a risk and how high the risk is and the relation with ODD.
what about the validity? So this means that teachers do posses infromation about how well the family is functioning. They’re are not good observers, but they observe something.
general conclusion.
general discussion. Even experts are not able to see what are the real signals of sexual abuse, so lecturer thinks effect of sexual abuse might be quite diverse: anxious, despressed, agressive. It’s not that they’re demonstrating odd sexual behavior, so it’s hard to see. Third step was skipped often, becasue they were afraid to break a relationship and they wouldn’t be able to reach this family anymore. So they developed a training to get them talking. It was effective: teachers felt more confident about talking with parents about child maltreatment. But at the long term, they did not see effect on the quality of the screening of child maltreatment.

Trauma and stress related disorders
DSED is not know by all professionals. RAD is too often diagnosed on the other hand. DSED: friendliness to every stranger they meet, but develop no relationship with them.
not only structure, but also function of brain changes. But also stress and hormonal system change. Even physical problems can occur later on, like developing cancer or heart problems, and problems regarding mental health, all caused by early life stress. Stress system develops during pregnancy, so stress of mother during pregnancy, also influences this.
Trauma is a more specific form of early life stress. The consequences are large, even if you don’t remember the experiences anymore cause you were too young.

Stress
internal process of homeostasis. The aim of stress reaction is actually to restore homeostasis.
you can become more sensitive to stress due to extreme stress. The allostatic load becomes too high. And then you can get all these consequences. So, altered state of homeostatis, also called allostasis, can lead to negative consequences.

Positive and negative effects of stress
not every form of stress has a negative effect, you need to experience stress to develop properly, optimal funcitoning stress system.
positive stress. Important that they have supportive and responding family.
tolerable stress. You can restore the systems if supporting parents.
toxic stress: heavy stress with no parental support. When cortisol is produced at very high level, it can change brain.

HPA-axis
talking about stress system actually is HPA-axis. Hypothalamus, hypofyse en bijnierschors. Inconsistent results, so still a puzzle.
1st period: Hyposensitive period: child start with high level reaction to stress. But due to transitions with physical and womb, contact with parents, it will turn to hyporesponsive period. Child is acting less and less stressful to all these types of stress events.
you could say caregivers are the regulators of the HPA-system.
2nd period: increased stress system with higher levels of cortisol system. Parents do not have the same effect on this period as when children were young. Parents do not longer act as a buffer. Relationships with peers do.
ELS can turn HPA-axis to develop in other direction, so stress later on in life will be experienced heavier.

Brain development
many structures in the brain that will change. Even parts that will be destroyed by high amounts of cortisol. Hippocampus allows you to store all the events you experience which are important to remember, helps to restore these experiences in the long term memory system. So if hippocampus is destroyed partly by high levels of cortisol, then memories of early events will be redescribed. It won’t be the real event anymore.

Neurobiologic
Neurobiological changes won’t be asked in exam. Different types in these changes by different types of child maltreatment. The effect of maltreatment on the brain will be different regarding the type of maltreatment.

Week 42

HC intellectual disorders

Foto’s:
Different etiologies for intellectual disabilities.

Terminology and definitions:
cerebral palsy: fluid in your brain, much spasm. So person with cerebral palsy belongs to group with developmental disability.
EMB à combination of severe DD and very severe motor disabilities.
AAIDD: most used and acknowledged defintion. The mean is 100 and standard deviation is 15. So 2 standard deviations means IQ less than 70. And realibility range is included. Social skills is also motivation.
and thus only diagnosed when under 22 years.
borderline intellectual disability: if IQ between 70-85, but also adaptive problems

Levels of ID
if collect data of IQ of whole population adults, you will see that majority reaches a certain score, a raw score on intelligence test. This mean, the top of the bell curve, we call it 100. This is normal for the population. People who have higher raw score, it’s rare. Only 2,1% were scoring more than 2 standards deviations higher than the mean for example. We have a bell curve for each age group. Different age groups have different means of the raw scores. The mean of the raw scores is set on 100. 85% if all people with ID have mild ID. this borderline group (only in the Netherlands), we call them also persons with mild ID. it will raise costs when you lower the boundaries of ID, because more people are diagnosed. However, it is needed, cause our society is getting more and more complex.
borderline personality disorder is something different than borderline ID.
below 50 we also distinct between moderate, severe and profound, but this is strange, as we can’t test below 50. It has no meaning. So in the Netherlands we see it’s not a valid distinction and we will not use it. but in DSM it’s still used. In other countries, they look at the functioning. Severe disability if you fucntion at the level of a 2 year old. Lecturer isn’t fond of this kind of comparing.

AAID multidimensional model
there is only a very small group of total group with intellectual disability! Severity is not dependent on cognitive functioning, but on how much support you need. So another way of thinking.
often comorbidity in ID. additional diagnosis, like ADHD, autism, etc…
lecturer prefers model of needed support, in the Netherlands this is the most preferred model. More looking at adaptive skills than at IQ itself.
the amount of support a person needs is dependent on these 5 dimensions.

Etiology:
in half of the cases we don’t know.
distinguish between 2 groups à 2 group approach. Organic for example related to defected gene. Cultural familial: cause is most likely multidimenstional, child does not has the chance to develop normally, often related to low SES. Still genes involved.
Low and high SES parents have equal chance of getting a child with organic cause; it’s not directly related to SES factors of parents. Cultural familial however is related to SES. And probable polygentetic.

The two-group approach
the distinction is rather arbitrair. In cases of extreme forms of deprivation, it can cause abnormalities in brain development and this is organic. So we cannot exclude that environmental circumstances can have organic results. So it’s not quite true that organic is related to severe disability and familial to mild disability.
person with william syndrom doesn’t sound like has ID. but they have it on other areas, like visual spatial orientation.
thus the lecturer says we need to look more at the strengths and weaknesses.
Some other problems with the 2 group approach as well, see slide. Difficult to distinguish between deficit and developmental delay.

Multifactor causation
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Behavioral phenotypes
we have increased knowledge on the relation between brain development and behavorial phenotypes. An example is fragile x syndrom. Often mild ID and facial dysmorphi if fragile x syndrom. FXS and Autism can be misdiagnosed, because both not looking at eyes, but for different reason.

FXS
disturbance in the distrubition/development of dendrites. This might explain why particular strengts and weaknesses.

Williams syndrome
deletion of piece of DNA. Visual/spatial orientation problem.

Disabilities in the Netherlands
some people are undetected off course.

Prevalence of ID
given distribution of IQ-scores we would expect 2%, because bell curve shows 2% below IQ 70. The most likely explanation is that the other 1% is undetected.

Trends in prevalence
increasing complexity of our society. Aging is a factor as it has to do with medical care; medical care have become better.

Trends in disability care
deinstutionalization. Decentralization. It is important to remember the laws for people with ID and why we do this. And government policy.

Expertise in the Netherlands
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Intelligence
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Stability of IQ
it’s pretty stable. Before age of 5, stability is very low à developmental path each child is following, differs a lot between children. In children with mild ID, it’s low.

Flynn-effect
Flyn effect is going to the reversed. Next generation migth be less intelligent. Might have to do with maternal age.

Psychopathology
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Intervention and treatment
to change behavior into more proper behavior, often applied behavioral analysis.
2 broad viewpoints:
1à look at relations, don’t treat humans like animals.
2à its very effective, so why not use it for people with ID.

Week 43

HC Dyslexia and dyscalculia

Mathematics:
even animals have it innate.

That we immediately see the difference between small amounts is called subitizing. After that you need to count.
after 3 amount, you need more time and make more mistakes.
an exception is gestalt-objects: you don’t count but see the whole object. Habituation à not being interested anymore when seeing the same thing once in a while.

Mathematics is a system of agreement. However often recently. Romains didn’t had position system with hundreds or tens. And number 0 only since 6ht century.
we don’t have brain cells specially for mathematics. Learning by practice and education.

Dyscalculia
conservation à like same amount of water in different bottle seizes. Has to do with reversed thinking. Spatial manipulation.
recent research says children can do this from 5 months of age already.
development is dependent on language skills and other mathematical abilities.

correspondence à ordering by ways of pairs
disability is visible before child can count, so very early visible

classification à logical
important for later number sense

seriation à making some kind of order based on characteristic of objects
not to do with amount, but sequence or size. Is not a prerequisite of mathematics, develops at the same time.

Counting

Math language à system of agreement. Some specific rules and symbols as well.
repetition and practice.

Measuring knowledge à everyting is relative untill you know the sort of amount

Automation à know certain sums by hart. This acquisition of knowledge goes in some steps. In the end you should be able to use it in daily live and combine things. When problems with automation, then difficulty with mathematics or dyscalculia.

Definition
even though good education, still have problems with mathematics. They always fall back to rudimental strategies, like scoring.
it’s a disorder, you have it for life. Psycholgoical function lower for mathematics than other areas. Comorbid with dyslexia often.

Very strict tests of dyscalculia.

Examples
-number line principle (7 between 6-8)
everyting is completely new tot hem

Falling back on really rudimentary strategies. So very soon problems in daily life.
film; what is hard: sequences, counting backwards, poor understanding of math symbols, numbers and adding up does’t mean something,

Diagnosis
1a, 1b, 1c is typical performance. Some differences in typical performance. sometimes remedial teaching is necessary. If still struggling, than maybe discalculia. Then point 2: diagnosis. If diagnosis is made, help is put in place. 3 is evaluate treatment. Dyscalculia never goes away, only learning how to deal wit hit. Two arrows. First is for importance of information: talk to teacher, to parents, do assignments with the child, etc. Second for importance of feedback: contact with parents and teacher to see how everyting is going after you started giving help.

No diagnosis below IQ of 70 because you can not see whether pracitcal problems are due to mathematical problems.

When lot of mathematical education, and no improvement than probably dyscalculia.

Treatment
example of how you can help children with math problems in normal classes.
dutch mathematics education is not so good.

look at proximal development: what can child already do, go through steps. Calculator is beneficial as it shows the som. Fixed structure.

often different strategies, important to stick to one. Self-instruction was found important.

what can parents do? Children have low self esteem about math, so focus on positives! Teach mathematics to play and focus on other things.

Dyslexia – origin of language
for humans it meens number of words and rules which give you infinite possibiities.

broca aphasia: difficulty speaking, but understand well
wnicke aphasia: fluent speach, but they dont understand
anomia: difficulty finding the right word to say

Normal language development
biological: when young development in certain regions
specification of brain is calles maturation

1. Equipotentially: 2 hemispheres the same, both ability to house language
2. Irreversible: brain is developed to have language on left side, only when something weird happens, then in rights side
3. Emergenist: innate characteristics which make it more probable for language to develop on left, but can be in right as well

Feral children could not learn langauage when young. Example of genie. Genie could learn words quite easily, but grammar was hard.

So cricital period hypothesis is not true, but sensitive period hypothesis is. So for early thing, the harder things like grammar, there seems to be quite a critical period, but for other things there isn’t.

Two routes of reading.
when learning to read, you use indirect route. At our age, we mainly use direct route.

Dyslexia – definition
automatisation is not going to well. 4th point is taken out.

Acquired dyslexias
when brain damage for example. Surface sylexia: prblem with reading irregular wordts. They take the phoneme route. It’s just about reading, they understand hearing.

phonological dyslexia
trouble reading pseudowords. Grahpem-phoneme conversions rules does not work.

Deep dyslexia
semantic reading errors. Similar to phonological dyslexia. But also use other words that relate to word they want to say.

Diagnosis
early identification is important, as developmental, so can help to diminish the later problems.

Treatment
first two mainly for younger children, last two for older children

Empirical research
[will not be on exam]

HC Developmental Language Disorder

It’s a frequent disorder.

Assumption
contrast between late and early language development has also contributed to this assumption

Jake
what did we notice in his language? Speaks slowly, weird pronunciation, concentration on building sentences, correcting himself, grammar errors.

Definition
normal hearing and intelligence. No neurologic damage. No obvious cause. So often DLD is seen as behavorial problem or low intelligence.
it’s not a speech disorder. Why that red would be like DLD.
it’s different from dyslexia, which is a written disorder. However children with DLD are often later diagnosed with dyslexia. But they are independent disorders.
different domains of language can be defected. Phonology: sounds. Morphology: word structure. Syntax: about sentence building. Semantics: meaning of words/finding the right words. Pragmatics: how you use language in interaction. Some children have problems in all domains, some in certain domains.

phonology: why non-word repetition à you don’t want to know word knowledge, but specific phonological memory
morphology: when you inflect a verb for example. Ommiting grammatical morphemes. Boy of 8 years still makes errors other make at age 2. Past tense was also not used by the boy. Image: boy overregularize irregular forms.

Jake
not use of past tense is clinical marker for DLD. They omit past tense morhpemes. But difference between type of morphemes seems to matter, because verbs like walking seem well able to do.

English vs Italian
why do we see cross linguistic differences.
how salient morphemes are? Hearing it better or not. Would explain why in Italian not problem with past, as more clear different morphemes. In italian clitics/pronounces are more difficult.

Syntax
using and understanding complex sentences is hard for children with DLD. Non-canonical word order is difficult, like passive voice. Relative clauses also important

semantics and vocabulary
less words and difficult finding words. They also use general verbs and nounces like do. So underspecified vocabulary.

symptoms
pragmatics in language is also hard for childrend with autism

development
shape/grow of development is the same. Gap remains quite stable for words. In grammar, differnt aspects of grammar are difficult.

problems in language spread problems in other domains.

socioemotional wellbeing
harder to build peer relations. Not severe enough problems to receive support.

academic and societal success
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interventions
not always succesful, depends on kind of disorder and severity. Mostly effective for mild forms of DLD.
 

Diagnosis by excluding causes
diagnosed by excluding causes. When child has language problem, exclude other problems and then diagnose.
if within lowest 10% of population in language test to get diagnosis DLD. And score below age expectations.

heterogenity
it’s a continuum. The cut-off is kind of arbitrary.

Etiology
no obivous cause. Large genetic component. It’s not only genes! Environment plays a role as well. Environment in the womb is also important for example, it can explain difference between MZ twins.

FOXP2
not a 1-gene solution however. FOX02 might be more in motor/speech. CNTAP2 involved in language. So it’s multiple genes and environment.

Environmental risk factors
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Brains
in most humans language in left hemisphere.

atypical lateralization
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Routes and underlying mechanisms
keep verbal information in short term memory to transform it to long term memory.
statistical learning: language contains patterns.
inhibition and working: planning language.
Sustained attention: less time to process it if not able to sustain attention
speed of ip

Domain specificity
because of underlying general mechanisms, not SLI called anymore.

terminology
is confusing, as many terms used.

Multilingual children
often diagnostic confusion with multilangual children. Monolingual children with DLD score same as mutlilingual children without DLD. So, symptoms of language development serve same symptoms as DLD. So hard to see whether multilinguals have DLD. Overrepresentation of children with migrant background in DLD. Relatively many children are overdiagnosed as DLD is genetic.

Solutions?
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Summary
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