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DSM Disorders in Children. ADHD + Behavioural Disorders. Classical Conditioning. Pavlov Dog is presented with meat powder to make it salivate Meat powder = Unconditioned Stimulus (UCS) Salivation = Unconditioned Response (UCR) A bell is rung before UCS is presented

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dsm disorders in children

DSM Disorders in Children

ADHD + Behavioural Disorders

classical conditioning
Classical Conditioning
  • Pavlov
    • Dog is presented with meat powder to make it salivate
        • Meat powder = Unconditioned Stimulus (UCS)
        • Salivation = Unconditioned Response (UCR)
    • A bell is rung before UCS is presented
        • Bell = Neutral Stimulus (NS)
    • Repetition leads to salivation on hearing the bell before any meat powder is presented
        • Bell = Conditioned Stimulus (CS)
        • Salivation = Conditioned Response (CR)
classical conditioning1
Classical Conditioning
  • Little Albert
    • Rat is presented to 11 month old boy who plays with it happily
        • Rat = Neutral Stimulus (NS)
    • Loud steel bar is struck behind Albert’s head after presenting with rat
        • Loud noise = Unconditioned Stimulus (UCS)
        • Fear = Unconditioned Response (UCR)
    • After 5 times, Albert shows extreme fear on presentation of the rat
        • Rat = Conditioned Stimulus (CS)
  • Behaviourism is the study of learning
      • i.e. Observable behaviour
  • Law of Effect:
    • Behaviour that is followed by consequences satisfying to the organism will be repeated, and behaviour that is followed by unpleasant consequences will be discouraged
operant conditioning
Operant Conditioning
  • Behaviour operates on the environment.
  • All behaviour, internal or external, can be explained by the environmental consequences it produces
  • “Stimulus-Response” becomes “Response-Consequence”

Freedom of choice is a myth and all behaviour is determined by the reinforcers provided by the environment

  • Reinforcement
    • Positive Reinforcement
      • Strengthening a tendency to respond in anticipation of a pleasant event (reinforcer)
    • Negative Reinforcement
      • Strengthens a response by removing an aversive event
    • Modeling – e.g. sharing, aggression, fear.
  • Punishment
    • Can lead to anxious responses, or be taken as a reinforcer if followed by a reinforcer
      • E.g. Child may seek punishment or abuse because the guilty parent may follow it with love
behavioural therapy
Behavioural Therapy
  • Extinction: Fading out of conditioned response through appropriate reinforcement
  • Counterconditioning: Eliciting a new response to a stimulus, using positive reinforcers
    • Systematic Desensitization:
      • 1. Deep muscle relaxation
      • Gradual exposure
    • Aversive conditioning: Pairing an attractive stimulus with an unpleasant event
skinner 1948 the superstitious pigeon
Skinner (1948) The Superstitious Pigeon

Eight pigeons received reward every 15 seconds

      • One bird conditioned to turn counter-clockwise
      • One repeatedly thrust its head into the upper corner of the cage
      • Pendulum motion “dance”
      • Incomplete pecking movements
  • Reinforcement interval increased to one minute
      • Movements became more energetic
  • Extinction
      • Took up to 10,000 responses before extinction occurred in one case
skinner 1948
Skinner (1948)
  • Non-contingent reinforcement
    • Behaviour is accidentally reinforced leading to a belief in a causal relationship between behaviour and reward
    • A relationship does still exist between the reward and the subject
  • Can produce a feeling of strength and control, reduce anxiety, improve performance
locus of control
Locus of Control
  • As a child develops, behaviours are learned which are followed by some form of reinforcement
  • Reinforcement increases child’s expectancy that behaviour will produce desired reinforcement
  • External locus of control
    • Interpreting consequence as controlled by luck, fate or powerful others
  • Internal locus of control
    • Interpreting ones own behaviour and personality as responsible for consequences
applied behaviour analysis
Applied Behaviour Analysis
  • Improves level of functioning in Mental Retardation, learning Disabilities and Autism
  • Target behaviour is reinforced in small levels (e.g. Eating – picking up spoon, scooping food, moving spoon to mouth, remove with lips etc)
  • Inappropriate and self-injurious behaviour is reduced (e.g. rocking, swaying, aggression)
  • Can bring children with severe cases of Autism to basic levels of social functioning by age 7.


  • http://www.youtube.com/watch?v=gbH_jpYlYew
  • http://www.youtube.com/watch?v=hulVH9jpR8k
  • http://www.youtube.com/watch?v=PPWL5yimhyg
stage 3 18 months 4 years
Stage 3: 18 months – 4 years
  • Security in seperateness allows the child to experiment with their own volition
  • Conscious self begins to emerge  development of the ego
  • Beginning of control of impulses  delayed gratification
  • Development of language
stage 3 language
Stage 3: Language
  • Sub-units of behaviour (stimulus-response/response-consequence) are organised into patterns/sets

 Cause & Effect according with environment

  • Exploration of environment begins formation of cognitive map
  • Operant units store in cognitive maps
  • Associated with neural learning networks (enhanced with stimulation)
stage 3 operant units
Stage 3: Operant Units

A - B - C

word picture object

Association of arbitrary units

C - A

Object word

Backward association

Most important evolutionary leap in development of human language which is apparently unique to the human

stage 3 language1
Stage 3: Language
  • Primary language - images and emotions
  • Cognitive language develops from associations of arbitrary units, not only by direct teaching
  • Early associations will be more general,
    • e.g. “Dog” may become the word for any external object, or any black object
    • “Dada” may refer to all males
  • Psychological associations become more complex, arising in logical thought
  • Memory as we know it may correspond with the development of language, hence people “not remembering” their early years
stage 3 will
Stage 3: Will
  • As identity separates into an individual unit, the child develops the power to choose their own actions
      • Action-Consequence
      • I am what I do
  • Good-bad associations with self (pleasure/ guilt) are controlled by the inner executive (central executive functions)
  • The right to act in awareness of punishment and obedience
    • E.g. the hot stove
stage 3 trauma
Stage 3: Trauma
  • Improperly restricting the child may result in decreasing will, thus decreasing spontaneity and confidence
  • May cause stunting of inner authority – the right to be free
stage 3 comparative models
Stage 3: Comparative models
  • Erikson: Autonomy vs shame and guilt
  • Reich/Lowen: Masochist (Endurer) structure
    • Psychopath challenger-defender
stage 3 comparative models1
Stage 3: Comparative models
  • Piaget: Preoperational
    • Increase in speed of movement and thought
    • Symbolic thought and language development
    • “Magic” thought
    • Animism (living objects)
    • Egocentric world-view
stage 3 comparative models2
Stage 3: Comparative models
  • Freud: Anal stage
    • Toilet training: obsession with the erogenous zone of the anus with retention or expulsion of feces
    • Social pressures put on internal pleasure
    • Stubbornness or malicious excretion
    • Anal expulsive character: messy, disorganised, careless and defiant
    • Anal retentive character: neat, precise, orderly, careful, with-holding, passive-aggressive
    • Possession and attitudes towards authority

Freud did not reach his discoveries through a clearly defined scientific methodology

Careful observations of patients over decades of clinical analysis

Many Freudian theories cannot be tested scientifically

Many are proven to be unreliable

freudian personality structure
Freudian Personality Structure
  • Id
    • Basic biological urges – hunger, thirst, sexual impulse
      • Pleasure principle
      • Immediate gratification, regardless of reason, logic, safety or morality
      • Constantly seeks expression
      • Operates at an unconscious level
    • Eros and Thanatos
freudian theory
Freudian Theory
  • Ego
    • Limits and controls the impulses of the id
      • Reality Principle
      • Alert to the real world (conscious) and the consequences of behaviour
      • Satisfies id’s urges using rational means which are reasonably safe and socially acceptable
freudian theory1
Freudian Theory
  • Superego
    • Limits the ego to moral and ethical internalised rules between good and bad.
    • Instilled by your parents (locus of control)
    • Conscience – controls with guilt
    • Operates on both conscious and unconscious levels
freudian theory2
Freudian Theory

The ego tries to balance the needs and urges of the id with the moral requirements of the superego

Psychopathology is an imbalance or malfunction, usually if the demands of the id are too strong to be controlled

Anxiety arises with fear – free-floating anxiety causing the onset of defense mechanisms

defense mechanisms
Defense Mechanisms
  • Psychological mechanisms to protect against anxiety
  • Self-deceiving and reality-distorting
    • Repression
    • Regression
    • Projection
    • Reaction Formation
    • Sublimation
defense mechanisms1
Defense Mechanisms
  • Repression
    • Forcing disturbing thoughts out of consciousness
    • Anxiety associated with “forbidden” thoughts is avoided – usually sexual desires
    • Hidden conflicts may be revealed through slips of the tongue, dreams, psychoanalysis, free association or hypnosis
    • Psychological problems can arise in the form of neuroses
defense mechanisms2
Defense Mechanisms
  • Regression
    • Ego guards against anxiety by causing the person to retreat to the behaviour of an earlier stage of development
    • Earlier speech patterns, childlike behaviour
    • Mid-life crises
    • Going home to mother when there is a marriage problem
defense mechanisms3
Defense Mechanisms
  • Projection
    • Unconscious urges are noted in other people’s behaviour
    • Externalising anxiety-provoking feelings to reduce anxiety
    • E.g. Husband feeling impulses of being unfaithful may project his desires onto his wife by becoming insanely jealous and angry
    • Projections are truly believed
defense mechanisms4
Defense Mechanisms
  • Reaction Formation
    • “The Lady doth protest too much, me thinks”
    • Engages in behaviours that are the exact opposite of the id’s real urges
    • Exaggerated or obsessive
    • Complete rejection blocks anxiety
    • E.g. homophobia – gay bashing
defense mechanisms5
Defense Mechanisms
  • Sublimation
    • Finding socially acceptable ways of discharging energy that is the result of unconscious forbidden desires
    • Necessary for a productive and healthy life
    • Through evolution of civilisation, humans sublimate their primitive biological impulses
freudian theory3
Freudian Theory
  • Ramachandran (1995) examined a neuropsychological cause of repression in paralysed patients
    • Patients who are paralysed on one half of their body who show repression
    • Always choose impossible two-handed tasks instead of one-handed tasks
    • Show no disappointment when they fail
    • Vestibular irrigation brought back repressed feelings in some patients
freudian theory4
Freudian Theory
  • Homophobia
    • Homophobics more aroused by homosexual stimulus than non-homophobics
    • Under-report their arousal
  • Anna Freud and others have written extensively on Freudian theory and focused it into scientifically testable areas
attention deficit hyperactivity disorder

Attention Deficit: difficulty sitting still (e.g. class/meals)

Hyperactivity: unable to stop moving or talking


- Disorganised, erratic, tactless, obstinate and bossy

- Difficulty getting along with peers and establishing friendships

- (in part due to: ) aggressiveness, annoying and intrusive behaviours

- different social goals (e.g. sensation seeking over team-work)

- Miss social cues (may recognise social cues in cognitive exercises but not in actuality)

3 – 7% of school-age children worldwide

Attention Deficit/Hyperactivity Disorder
attention deficit hyperactivity disorder1

15 – 30% of children with ADHD have a learning disability in math, reading or spelling

Often put in special education because of difficulty with classroom environment

Overlap of 30-90% between ADHD and Conduct Disorder

ADHD is associated with earlier age of onset of Conduct Disorder symptoms

Attention Deficit/Hyperactivity Disorder
attention deficit hyperactivity disorder2

30% of ADHD diagnoses comorbid with internalizing disorders (e.g. Depression and anxiety)

65-80% of children with ADHD still meet criteria for the disorder in adolescence.

Up to 50% of children meet the criteria in adulthood (Rates vary depending on method of assessment)

Attention Deficit/Hyperactivity Disorder
diagnosis of adhd

Predominately Inattentive type

  • Predominately Hyperactive-Impulsive type
  • Combined type
Diagnosis of ADHD
etiology of adhd


    • Heritability estimates as high as 70-80%
    • 50% of children from ADHD parents are likely to have it
    • Genetic evidence associated with Dopamine neurotransmitter
  • Neurobiology:
    • Frontal Lobe Dysfunction:

- Lobes are under-responsive, under-sized.

- Cerebral blood flow is reduced

    • Tobacco/Nicotine:

- Environmental toxins, food additives, Lead poisoning

- Low birth weight and maternal coldness

Etiology of ADHD
etiology of adhd1


  • Parent-Child relationships:

- Commanding, negative parents AND less compliant, negative kids

- Child behaviour has a negative effect on parents’ behaviour

Etiology of ADHD
treatment of adhd

Stimulant Medications:

- Methylphenidate (MPH)

e.g. Ritalin, Adderall

- Reduce disruptive behaviour

- Improve concentration and goal-directed activity in 75% of cases

- 80% of 11 million prescriptions between 1996-2000 were for children diagnosed with ADHD (problems with diagnosis?)

- Side-effects: loss of appetite, sadness, headaches, stomach aches

Treatment of ADHD
treatment of adhd1

Psychological Treatment

- Behavioural conditioning (point systems, reward charts, etc)

Combinations most effective cross-culturally

Treatment of ADHD
conduct disorder including oppositional defiant disorder


- Aggression and cruelty toward people or animals, damaging property, lying and stealing

- Callousness, viciousness, lack of remorse

 Adult antisocial personality disorder

4-16% of boys, 1.2-9% of girls

Behaviour peaks at 17 and reduces in young adulthood

Conduct Disorder(Including Oppositional Defiant Disorder)
conduct disorder

Life-course Persistent form: shows problems from age 3 into adulthood

Adolescent limited

15-45% comorbidity with Anxiety and Depression

Most likely to occur with parent of low verbal intelligence or antisocial personality disorder

Conduct Disorder
etiology of conduct disorder


    • Vague and mixed
      • MAOA gene – Monoamine Oximade enzyme metabolizes neurotransmitters.
      • Children who have low MAOA activity AND are maltreated are more likely to develop conduct disorder
Etiology of Conduct Disorder
etiology of conduct disorder1


    • Poor verbal skills
    • Executive functioning (self-control, planning)
    • Memory problems
Etiology of Conduct Disorder
etiology of conduct disorder2


    • “Moral Awareness”
      • Guilt, altruism
    • Physical abuse
    • Reinforcers
      • Agression reinforced by achieving a goal
      • Interpretation of ambiguous acts as aggressive
      • Peer groups
    • Harsh and inconsistent parental discipline
    • Sociocultural factors – educational facilities, family life, neighbourhoods etc
Etiology of Conduct Disorder
treatment of conduct disorder

Parental Management Training (PMT)

  • Multisystemic Treatment
    • Family, school, community and peers
  • Cognitive therapy
    • Anger management, etc.
Treatment of Conduct Disorder