ANGIRA GUPTA

CLINICAL PSYCHOLOGY
Psychopathology - 2
Pervasive Developmental Disorders:
Autism Spectrum Disorder
➔ ASD is a disorder characterized by significant and persistent deficits in social
communication and interaction skills and restricted, repetitive patterns of behaviors,
interests, or activities.
➔ ASD has increasingly come to be recognized as a biologically based lifelong
neurodevelopmental disorder that is present in the first few years of life.
➔ Children with ASD behave in unusual and frequently puzzling ways.
➔ They may spend hours engaging in stereotyped or repetitive motor activities or focus
on minuscule details of their world rather than their entire environment.
ASD is defined as a spectrum disorder because its symptoms, abilities, and characteristics are
expressed in many different combinations and in any degree of severity (Lai et al., 2013).
Thus, ASD is not an “all or nothing” phenomenon. At one end of the spectrum we may find a
child who is mute, crouched in a corner of his room, spinning a paper clip over and over
again for hours; at the other end of the spectrum is a researcher who is also able to hold a
corporate job—as long as it doesn’t require interacting with customers.
This disorder characterised as in DSM-5:
● Persistent deficits in social communication and social interaction across multiple
contexts
● Specify current severity based on social communication impairments and restricted,
repetitive patterns of behavior.
● Specify current severity based on social communication impairments and restricted,
repetitive patterns of behavior.
Core Deficits of ASD:
➔ Children with ASD experience profound difficulties in relating to other people,
including deficits in orienting to social stimuli, imitating others, sharing a focus of
attention with others, and noticing and understanding other people’s feelings. They
also display deficits in social communication, including the use of preverbal
vocalizations and gestures, language oddities such as pronoun reversal, and
difficulties with the appropriate use of language in social contexts.
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➔ Children with ASD exhibit restricted and repetitive patterns of behaviors, interests,
and activities. These generally fall into two categories: (1) repetitive sensory and
motor behaviors, which include unusual sensory interests, over sensitivities or under
sensitivities to certain stimuli, stereotyped hand and body movements, and repetitive
speech or object use, and (2) insistence on sameness behaviors, which include
compulsions and rituals, and resistance to change.
Associated Characteristics of ASD:
➔ Previous estimates were that about 70% of children with ASD also have ID. However,
recent reports suggest that ID in individuals with ASD is closer to 40% to 50%, a
decrease that is most likely related to increased diagnoses of ASD in
higher-functioning individuals and to the effects of early intervention.
➔ Children with ASD display a deficit in theory of mind (ToM)—the ability to
understand other people’s and one’s own mental states, including beliefs, intentions,
feelings, and desires.
➔ Children with ASD display a general deficit in higher order planning and regulatory
behaviors (e.g., executive functions).
➔ They may display co-occurring medical conditions and physical features such as
seizures, sleep problems, gastrointestinal symptoms, or increased head size.
➔ Children with ASD may display co-occurring symptoms of ADHD, conduct
problems, anxieties and fears, and mood problems.
Causes of ASD:
➔ ASD is a biologically based neurodevelopmental disorder that may result from
multiple causes.
➔ Some children with ASD experience prenatal and neonatal complications such low
birth weight, bleeding during pregnancy, toxemia (blood poisoning), viral infection or
exposure, and a lack of vigor after birth.
➔ ASD is a genetic disorder, although specific genes with large effects have not been
identified. More likely, ASD is a complex genetic disorder resulting from rare
mutations and simultaneous genetic variations in multiple genes. Shared
environmental experiences and epigenetic factors may also be involved.
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➔ Nonautistic relatives of individuals with ASD display higher-than-normal rates of
social, language, and cognitive deficits that are similar in quality to those found in
ASD, but are less severe and are not associated with intellectual deficits or epilepsy.
➔ Neuropsychological impairments occur in many areas of functioning, including
intelligence, attention, memory, language, and executive functions.
➔ Structural abnormalities in the cerebellum and the medial temporal lobe, prefrontal
cortex, and related limbic system structures have been found.
➔ ASD is not represented by a localized abnormality in one part of the brain but rather
by a lack of normal connectivity and communication among brain networks that
underlie the core features of ASD.
➔ The relationship between the child’s early risk for ASD and later outcomes will be
mediated by how the child interacts with and adapts to his or her environment.
Treatment of ASD:
➔ Treatments for ASD are directed at maximizing the child’s potential and helping the
child and family cope more effectively with the disorder.
➔ Treatments for ASD focus on the specific social, communication, cognitive, and
behavioral deficits displayed by children with this disorder.
➔ The most effective treatments use highly structured skill oriented strategies that are
tailored to the individual child and provide education and supportive counseling for
the family.
➔ Nearly all children with ASD benefit from early intervention; however, controlled
studies are needed to evaluate long-term outcomes.
➔ Medications may help in alleviating some symptoms. However, their benefits are
limited, variable from child to child, and do not change the core deficits of children
with ASD.
ADHD (Attention-deficit-hyperactivity disorder):
Attention-deficit-hyperactivity disorder (ADHD) is manifested in children who display
persistent age-inappropriate symptoms of inattention, hyperactivity, and impulsivity that
cause impairment in major life activities. ADHD can only be identified by characteristic
patterns of behavior, which vary quite a bit from child to child. The behavior of children with
ADHD is a constant source of stress and frustration for the child and for parents, siblings,
teachers, and classmates; it also has high costs to society. The disorder that we now call
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ADHD has had many different names, primary symptoms, and presumed causes, and views
of the disorder are still evolving.
ADHD is included in DSM-5 as a neurodevelopmental disorder because it has an early onset
and persistent course, is associated with lasting alterations in neural development, and is
often accompanied by subtle delays and problems in language, motor, and social
development that overlap with other neurodevelopmental disorders such as autism spectrum
disorder (ASD) and specific learning disorder (APA, 2013).
Core Characteristics:
● DSM-5 uses two lists of symptoms to define ADHD. The first list includes symptoms
of inattention, poor concentration, and disorganization. The second list includes
symptoms of hyperactivity–impulsivity.
● Children who are inattentive find it difficult to sustain mental effort during work or
play and find it difficult to resist salient distractions while doing so.
● Children with ADHD are extremely active, but unlike other children with a high
energy level, they accomplish very little.
● Children with ADHD are impulsive, which means they seem unable to bridle their
immediate reactions or they may fail to think before they act.
● A diagnosis of ADHD requires the appearance of symptoms before age 12, a greater
frequency and severity of symptoms than in other children of the same age and
gender, persistence of symptoms, occurrence of symptoms in several settings, and
impairments in functioning.
● There must be clear evidence that the symptoms interfere with, or reduce the quality
of, social academic, or occupational functioning.
Presentation Type:
Presentation type refers to a group of individuals with something in common— symptoms,
etiology, problem severity, or likely outcome—that makes them distinct from other
groupings. DSM specifies three presentation types of ADHD based on the individual’s
primary symptoms:
● Predominantly inattentive presentation (ADHD-PI) describes children who meet
symptom criteria for inattention but not hyperactivity–impulsivity.
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● Predominantly hyperactive–impulsive presentation (ADHD-HI) describes
children who meet symptom criteria for hyperactivity-impulsivity but not inattention.
● Combined presentation (ADHD-C) describes children who meet symptom criteria
for both inattention and hyperactivity–impulsivity.
Associated Characteristics:
➢ Besides their primary difficulties, children with ADHD display other problems, such
as cognitive and learning deficits, speech and language impairments, motor
incoordination, medical and physical concerns, and social problems.
➢ Children with ADHD display deficits in executive functions (EFs), the higher-order
mental processes that underlie the child’s capacity for planning and self-regulation.
➢ Many children with ADHD have a specific learning disorder, typically in reading,
spelling, or math.
Causes:
1. There is strong evidence that ADHD is a neurodevelopmental disorder; however,
biological and environmental risk factors together shape its expression.
2. Specific gene studies suggest that ADHD is inherited, although the precise
mechanisms are not yet known.
3. Many factors that compromise the development of the nervous system before and
after birth may be related to ADHD symptoms, such as pregnancy and birth
complications, maternal smoking during pregnancy, low birth weight, malnutrition,
maternal alcohol or drug use, early neurological insult or trauma, and diseases of
infancy.
4. Less activity in certain regions of the brain.
5. Psychosocial factors in the family do not typically cause ADHD, although they are
important in understanding the disorder. Family problems may lead to a greater
severity of symptoms and relate to the emergence of co-occurring conduct problems.
Treatment:
There is no cure for ADHD, but a variety of treatments can be used to help children cope
with their symptoms and any secondary problems that may arise over the years. The primary
approach to treatment combines stimulant medication, parent management training, and
educational intervention.
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1. Stimulants are the most effective treatment for managing symptoms of ADHD;
however, their limited long-term benefit raises important issues about their clinical
use that are yet to be resolved.
2. Parent management training (PMT) provides parents with a variety of skills to help
them manage their child’s oppositional and defiant behaviors and cope with the
difficulties of raising a child with ADHD.
3. Educational interventions focus on managing inattentive and hyperactive–impulsive
behaviors that interfere with learning and on providing a classroom environment that
capitalizes on the child’s strengths.
ODD (Oppositional Defiant Disorder) & CD (Conduct Disorder):
Defining Features:
➔ Children with oppositional defiant disorder (ODD) display an age-inappropriate
pattern of stubborn, hostile, and defiant behaviors that reflect symptoms of
emotionality and temperamental activity. ODD symptoms can be grouped into three
dimensions: negative affect, defiance, and vindictiveness.
➔ Conduct disorder (CD) describes children who display severe aggressive and
antisocial acts involving inflicting pain upon others or interfering with the rights of
others through physical and verbal aggression, stealing, or committing acts of
vandalism.
➔ Children who display childhood-onset CD (before age 10) are more likely to be boys,
show more aggressive symptoms, account for a disproportionate amount of illegal
activity, and persist in their antisocial behavior over time.
➔ Children with adolescent-onset CD are as likely to be girls as boys and do not display
the severity of psychopathology that characterizes the childhood-onset group.
➔ There is much overlap between CD and ODD. However, most children who display
ODD do not progress to a more severe CD.
➔ Persistent aggressive behavior and conduct problems in childhood may be a precursor
of adult antisocial personality disorder (APD), a pervasive pattern of disregard for,
and violation of, the rights of others.
➔ A subgroup of children with conduct problems display psychopathic features,
including callous–unemotional (CU) traits such as lacking in guilt, not showing
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empathy, and not displaying feelings or emotions. These children also display a
preference for novel and perilous activities and a diminished sensitivity to cues for
danger and punishment when seeking rewards.
➔ Youth with CD who display a pattern of interpersonal and emotional functioning
involving a lack of remorse or guilt, empathy, or concern about performance.
Associated Characteristics:
1. Many children with conduct problems show cognitive, verbal, and language deficits,
despite their normal intelligence.
2. These children experience a variety of school difficulties, including academic
underachievement in language and reading, which may result from co-occurring
ADHD.
3. General family disturbances, and disturbances in parenting practices and family
functioning, are among the strongest and most consistent correlates of conduct
problems.
4. Children with conduct problems have interpersonal difficulties with peers, including
rejection and bullying. Their friendships are often with other antisocial children.
5. Antisocial behavior may be related to an inflated, unstable, and/or tentative view of
self.
6. Youths with conduct problems engage in many behaviors that place them at high risk
for health-related problems, including personal injuries, illnesses, sexually transmitted
diseases, and substance abuse
Causes: Conduct problems in children are best accounted for by multiple causes or risk and
protective factors that operate in a transactional fashion over time. Adoption and twin studies
indicate that genetic influences account for about 50% of the variance in antisocial behavior
➢ Genetic contributions to overt forms of antisocial behavior, such as aggression, are
stronger than for covert acts, such as stealing or lying.
➢ Antisocial behavior may result from an overactive behavioral activation system
(BAS) and an underactive behavioral inhibition system (BIS). Low levels of cortical
arousal and autonomic reactivity and deficits in the amygdala, prefrontal cortex, and
other brain regions play an important role, particularly for childhood-onset/persistent
CD.
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➢ Many family factors have been implicated as possible causes of children’s antisocial
behavior, including marital conflict, family isolation, violence in the home, poor
disciplinary practices, a lack of parental supervision, and insecure attachments.
➢ Family instability and stress, parental criminality and antisocial personality, and
antisocial family values are risk factors for conduct problems.
➢ The structural characteristics of the community provide a backdrop for the emergence
of conduct problems by giving rise to community conditions that interfere with the
adoption of social norms and the development of productive social relations.
➢ School, neighborhood, and media influences are all potential risk factors for antisocial
behavior, as are cultural factors, such as minority group status and ethnicity.
Treatment and Prevention: Considerable efforts to help children and adolescents with
conduct problems have led to several approaches with some proven success.
1. The focus of parent management training (PMT) is on teaching parents to change
their child’s behavior in the home.
2. The underlying assumption of problem-solving skills training (PSST) is that faulty
perceptions and appraisals of interpersonal events trigger antisocial responses. The
focus is on changing behavior by changing the way the child thinks in social
situations.
3. Multisystemic therapy (MST) is an intensive approach that is carried out with all
family members, school personnel, peers, juvenile justice staff, and other individuals
in the adolescent’s life.
4. Recent efforts have focused on trying to prevent conduct problems through intensive
programs of early intervention/prevention.
The degree of success or failure in treating antisocial behavior depends on the type and
severity of the child’s conduct problem and related risk and protective factors.

ODD is more prevalent than CD during childhood, but by adolescence the two occur about
equally. The lifetime prevalence rates for ODD and CD are about 12% and 8%, respectively.
During childhood, conduct problems are about 2 to 4 times more common in boys than in
girls. This difference narrows greatly in early adolescence, due mainly to a rise in covert non
aggressive antisocial behavior in girls, and then increases again in late adolescence and
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beyond. Girls are more likely than boys to use indirect forms of relational aggression—for
example, verbal insults, gossip, or third-party retaliation.
There is a general progression of antisocial behavior from difficult early temperament and
hyperactivity, to oppositional and aggressive behavior, to social difficulties, to school
problems, to delinquent behavior in adolescence, to antisocial personality development, to
criminal behavior in adulthood. A significant number of children with conduct problems
continue to experience difficulties as adults, including criminal behavior, psychiatric
problems, social maladjustment, health and employment problems, and poor parenting of
their own children.

Reference: Abnormal Child Psychology, 6th ed. By Mash & Wolfe.