Nieuwe inzichten in gedragsstoornissen bij kinderen

Kinderen geven hun ouders wel eens een grote mond als ze hun zin niet krijgen en een ander kind slaan of schoppen is evenmin uitzonderlijk. Maar van een psychiatrische stoornis is pas sprake als meerdere van deze gedragsproblemen gedurende langere tijd samen voorkomen en leiden tot nadelige gevolgen zoals afgewezen worden door leeftijdgenoten. De twee meest relevante stoornissen hier zijn de Oppositioneel-opstandige gedragsstoornis en de Gedragsstoornis. De afgelopen jaren is ons inzicht in deze twee gedragsstoornissen gegroeid. Over deze nieuwe inzichten zal ik het hebben. Zij hebben betrekking op de aard van de Oppositioneel-opstandige gedragsstoornis, de neurobiologie van de gedragsstoornissen, de diagnostiek van jonge kinderen en de behandeling van gedragsstoornisse

The neurobiology of oppositional defiant disorder and conduct disorder: Altered functioning in three mental domains

Item does not contain fulltextThis review discusses neurobiological studies of oppositional defiant disorder and conduct disorder within the conceptual framework of three interrelated mental domains: punishment processing, reward processing, and cognitive control. First, impaired fear conditioning, reduced cortisol reactivity to stress, amygdala hyporeactivity to negative stimuli, and altered serotonin and noradrenaline neurotransmission suggest low punishment sensitivity, which may compromise the ability of children and adolescents to make associations between inappropriate behaviors and forthcoming punishments. Second, sympathetic nervous system hyporeactivity to incentives, low basal heart rate associated with sensation seeking, orbitofrontal cortex hyporeactiviy to reward, and altered dopamine functioning suggest a hyposensitivity to reward. The associated unpleasant emotional state may make children and adolescents prone to sensation-seeking behavior such as rule breaking, delinquency, and substance abuse. Third, impairments in executive functions, especially when motivational factors are involved, as well as structural deficits and impaired functioning of the paralimbic system encompassing the orbitofrontal and cingulate cortex, suggest impaired cognitive control over emotional behavior. In the discussion we argue that more insight into the neurobiology of oppositional defiance disorder and conduct disorder may be obtained by studying these disorders separately and by paying attention to the heterogeneity of symptoms within each disorder

Arrested motherhood : Parenting, cognitive distortions, and depressive symptoms in mothers being released from incarceration

Objective. The present study examines cognitive and emotional problems in mothers being released from incarceration. Design. Participants were 98 mothers who were about to be released or had just been released from incarceration, and 63 comparison mothers from disadvantaged areas with low socioeconomic status, both with young children. Mothers provided self-report data on parenting behaviors, cognitive distortions, depressive symptoms, and socioeconomic difficulties. Results. Mothers being released from incarceration reported less optimal parenting behaviors (i.e., less involvement and poorer monitoring) and higher levels of cognitive distortions and depressive symptoms than comparison mothers. Cognitive distortions and depressive symptoms were related to less optimal reported parenting behaviors. Conclusions. Cognitive distortions, depressive symptoms, and less optimal reported parenting behaviors may be factors in incarcerated and formerly incarcerated mothers, which might put their children at risk, beyond risks associated with low socioeconomic status

Emotion regulation and angry mood among adolescents with externalizing problems and intellectual disabilities

Background and aims: Cognitive behavior therapy targeting emotion regulation is found to be effective in decreasing externalizing problems, but little is known about the emotion regulation capacities of adolescents with externalizing problems and Mild Intellectual Disabilities or Borderline Intellectual Functioning (MID-BIF). Therefore, the aim of this study was to compare emotion (i.e., anger) regulation capacities, angry mood level and angry mood variability between two groups: adolescents with externalizing problems and MID-BIF and adolescents with exter-nalizing problems and average intelligence (AIQ). Methods and procedures: Participants in the MID-BIF (n =42, Mage =15.52, SD =1.43) and AIQ (n =39, Mage =13.67, SD =1.06) group completed questionnaires about emotion regulation dif-ficulties, emotion regulation strategies, and angry mood. Outcomes and results: Adolescents in the MID-BIF group reported fewer emotion regulation dif-ficulties, fewer maladaptive regulation strategies, and lower levels of angry mood than adoles-cents in the AIQ group. No between-group differences in angry mood variability were found. Lastly, adolescents in the MID-BIF group reported to use more behavioral than cognitive regu-lation strategies. Conclusions and implications: These findings provide a starting point in understanding emotion regulation and angry mood of adolescents with externalizing problems and MID-BIF and show that it is important to consider differences between cognitive and behavioral regulation processes

Arrested motherhood: Parenting, cognitive distortions, and depressive symptoms in mothers being released from incarceration

Objective. The present study examines cognitive and emotional problems in mothers being released from incarceration. Design. Participants were 98 mothers who were about to be released or had just been released from incarceration, and 63 comparison mothers from disadvantaged areas with low socioeconomic status, both with young children. Mothers provided self-report data on parenting behaviors, cognitive distortions, depressive symptoms, and socioeconomic difficulties. Results. Mothers being released from incarceration reported less optimal parenting behaviors (i.e., less involvement and poorer monitoring) and higher levels of cognitive distortions and depressive symptoms than comparison mothers. Cognitive distortions and depressive symptoms were related to less optimal reported parenting behaviors. Conclusions. Cognitive distortions, depressive symptoms, and less optimal reported parenting behaviors may be factors in incarcerated and formerly incarcerated mothers, which might put their children at risk, beyond risks associated with low socioeconomic status

Impaired Neurocognitive Functions Affect Social Learning Processes in Oppositional Defiant Disorder and Conduct Disorder: Implications for Intervention

Item does not contain fulltextIn this review, a conceptualization of oppositional defiant (ODD) and conduct disorder (CD) is presented according to which social learning processes in these disorders are affected by neurocognitive dysfunctions. Neurobiological studies in ODD and CD suggest that the ability to make associations between behaviors and negative and positive consequences is compromised in children and adolescents with these disorders due to reduced sensitivity to punishment and to reward. As a result, both learning of appropriate behavior and learning to refrain from inappropriate behavior may be affected. Likewise, problem solving is impaired due to deficiencies in inhibition, attention, cognitive flexibility, and decision making. Consequently, children and adolescents with ODD and CD may have difficulty learning to optimize their behavior in changeable environments. This conceptualization of ODD and CD is relevant for the improvement of the effect of psychological treatments. Behavioral and cognitive-behavioral interventions that have been shown to be modestly effective in ODD and CD are based on social learning. Limited effectiveness of these interventions may be caused by difficulties in social learning in children and adolescents with ODD and CD. However, although these impairments have been observed at a group level, the deficits in reward processing, punishment processing, and cognitive control mentioned above may not be present to the same extent in each individual with ODD and CD. Therefore, the neurocognitive characteristics in children and adolescents with ODD and CD should be assessed individually. Thus, instead of delivering interventions in a standardized way, these programs may benefit from an individualized approach that depends on the weaknesses and strengths of the neurocognitive characteristics of the child and the adolescent