ASD

A. Persistent Deficits in Social Communication and Social Interaction Across Multiple Contexts
This criterion focuses on challenges in three main areas of social interaction:
1. Social-Emotional Reciprocity:
 This refers to the natural give-and-take in conversation and social interactions, which
is notably impaired in individuals with ASD. For instance, they might not respond to
social interactions or might do so inappropriately, not share interests or emotions with
others, or fail to initiate or respond to social interactions.
2. Nonverbal Communicative Behaviors:
 These include difficulties in using and interpreting body language, eye contact, facial
expressions, gestures, and other nonverbal cues that are part of social interaction.
Individuals with ASD might have trouble making eye contact, display facial
expressions that don't match the context of the conversation, or have difficulty
understanding the nonverbal communication of others.
3. Developing, Maintaining, and Understanding Relationships:
 This involves difficulties adjusting behavior to suit various social contexts, sharing
imaginative play or making friends, or lack of interest in peers. Individuals might
struggle to make friends, show a lack of interest in people, or have difficulties
understanding how relationships work.
B. Restricted, Repetitive Patterns of Behavior, Interests, or Activities
Individuals must exhibit at least two of the following:
1. Stereotyped or Repetitive Motor Movements, Use of Objects, or Speech:
 This includes simple motor stereotypes, lining up toys or flipping objects, echolalia
(repeating words or phrases), or idiosyncratic phrases.
2. Insistence on Sameness, Inflexible Adherence to Routines, or Ritualized Patterns of
Verbal or Nonverbal Behavior:
 Examples include extreme distress at small changes, difficulties with transitions, rigid
thinking patterns, greeting rituals, or a need to take the same route or eat the same
food every day.
3. Highly Restricted, Fixated Interests that are Abnormal in Intensity or Focus:
 The individual might be preoccupied with unusual objects or excessively
circumscribed or perseverative interests. For instance, an intense preoccupation with
unusual objects or excessively detailed and restrictive interests.
4. Hyper- or Hypo-reactivity to Sensory Input or Unusual Interest in Sensory Aspects of
the Environment:
 This could manifest as apparent indifference to pain/temperature, adverse response to
specific sounds or textures, excessive smelling or touching of objects, fascination
with lights, or movement.
C. Symptoms Must Be Present in the Early Developmental Period
Symptoms typically manifest in early childhood but might only become fully apparent as social
demands exceed capacities.
D. Symptoms Cause Clinically Significant Impairment in Social, Occupational, or Other
Important Areas of Functioning
The impairment affects daily functioning in social, educational, or occupational environments.
E. These Disturbances Are Not Better Explained by Intellectual Disability or Global
Developmental Delay
While ASD can co-occur with these conditions, the social communication challenges are distinct and
exceed those typically associated with developmental delays.

Aetiology

1. Genetic Factors
Genetics play a significant role in the development of ASD. Studies suggest that ASD has a high
heritability rate, indicating that genetic factors are a primary contributor:
 Genetic Variations: Both common and rare genetic variations are associated with ASD.
These variations can include single nucleotide polymorphisms (SNPs) and copy number
variations (CNVs), which can affect gene function and brain development.
 Syndromic ASD: In some cases, ASD is part of a broader genetic disorder like Fragile X
syndrome, Tuberous sclerosis, and Rett syndrome. These syndromic forms help researchers
understand the genetic pathways that may influence ASD development.
 Family Studies: Increased rates of ASD and broader autism phenotype characteristics in
family studies suggest a genetic link. The recurrence rate for siblings of children with ASD is
much higher than in the general population, further supporting a genetic basis.
2. Environmental Factors
Environmental factors can influence the risk of developing ASD, particularly during prenatal and
perinatal periods. These factors include:
 Parental Age: Advanced parental age at the time of conception has been associated with a
higher risk of ASD in offspring.
 Prenatal Exposure: Exposure to certain substances during pregnancy, such as valproic acid
(used in the treatment of epilepsy) and possibly some other medications, has been linked to a
higher risk of ASD.
 Perinatal Complications: Complications during birth, including low birth weight, neonatal
anemia, and gestational diabetes, may also increase ASD risk. However, these factors are not
definitive causes but rather influence risk in conjunction with genetic predispositions.
 Environmental Pollutants: Some studies suggest a potential link between exposure to air
pollutants during pregnancy or early life and an increased risk of ASD, although more
research is needed to confirm these findings.
3. Neurobiological Factors
ASD is associated with various neurobiological changes that affect brain structure, connectivity, and
function:
 Brain Structure and Connectivity: Imaging studies have shown differences in the brain
structure and connectivity in individuals with ASD, particularly in areas related to social
cognition and communication. These can include differences in the size and connectivity of
the amygdala, which processes emotional information, and other neural networks involved in
social interaction.
 Neurotransmitter Systems: There is evidence to suggest that neurotransmitter systems,
particularly serotonin and gamma-aminobutyric acid (GABA), are involved in ASD.
Abnormalities in these systems could affect brain development and function.
 Immune Dysregulation: Some research indicates that immune dysregulation in the brain
could play a role in ASD. This includes findings of neuroinflammation in postmortem studies
of ASD brains, suggesting that immune responses could affect neural development.
Integrative Models
Most researchers agree that no single factor explains all cases of ASD; rather, it’s the interaction
between genetic predispositions and environmental influences that likely determines the risk. This
interaction affects early brain development and can lead to the diverse manifestations of ASD.
Etiological research continues to evolve, integrating these models to understand better how various
factors contribute to the development of ASD and its symptoms. This integrated approach is essential
for developing targeted interventions and support mechanisms for individuals with ASD and their
families.

Treatment

1. Behavioral Interventions
Behavioral interventions are the cornerstone of ASD treatment, focusing on improving specific
behaviors, such as social skills, communication, and academics, while also reducing behaviors that are
harmful or disruptive.
 Applied Behavior Analysis (ABA): ABA is one of the most researched and commonly
practiced interventions for ASD. It uses techniques such as positive reinforcement to teach
useful behaviors and skills. Within ABA, several subtypes include Discrete Trial Training
(DTT), Pivotal Response Training (PRT), and the Early Start Denver Model (ESDM).
 Structured Teaching and TEACCH: The Treatment and Education of Autistic and related
Communication-handicapped Children (TEACCH) program uses a person-centered approach
to help children and adults with ASD use their skills more effectively in social interactions. It
emphasizes structured environments and visual cues to support learning and behavior.
2. Educational Interventions
Educational interventions are tailored to meet the individual's developmental level and learning needs,
often incorporating specialized educational plans and support within school settings.
 Individualized Education Program (IEP): In the United States and many other countries,
children with ASD are entitled to an IEP, which outlines specific educational goals tailored to
their needs and abilities. These programs often include integration with typically developing
peers, as well as specialized interventions.
  Inclusive Education: Efforts are often made to include children with ASD in mainstream
classrooms where appropriate, with supports such as resource rooms or aide support.
3. Communication Interventions
Many individuals with ASD have difficulty with communication, and interventions often focus on
developing both verbal and nonverbal communication skills.
 Speech Therapy: Speech-language pathologists work to develop spoken language,
understanding, and practical communication skills.
 Augmentative and Alternative Communication (AAC): For non-verbal individuals or
those with severe speech limitations, AAC devices can range from picture exchange systems
to digital devices that generate speech.
4. Family Interventions
Family-centered interventions recognize the impact of ASD on the family unit and provide parents
and siblings with strategies to support the individual with ASD effectively.
 Parent Training Programs: These programs teach parents techniques to support their child’s
development and manage challenging behaviors. They help parents facilitate communication,
improve social skills, and implement practical behavior management strategies.
 Family Therapy: This can help all family members understand the challenges and strengths
associated with ASD, improving family dynamics and support.
5. Pharmacological Treatments
While no drugs can cure ASD, certain medications can be used to help manage specific symptoms
associated with the disorder, such as irritability, aggression, hyperactivity, anxiety, and depression.
 Antipsychotics: Medications such as risperidone and aripiprazole are approved by the U.S.
Food and Drug Administration (FDA) for treating irritability in children with ASD.
 SSRIs and Anti-anxiety Medications: These can help manage symptoms of anxiety and
depression that are common in individuals with ASD.
6. Other Therapies
 Occupational and Sensory Integration Therapy: These therapies are often used to help
individuals manage sensory sensitivities and improve motor skills and coordination.
 Social Skills Groups: These are structured groups that help individuals learn and practice
appropriate social skills in a safe environment, facilitated by a trained professional.
Emerging Interventions
 Technology-based Interventions: Including the use of virtual reality (VR) and video
modeling, these newer methods are being explored for their potential to provide engaging,
repetitive, and controlled environments for learning social and communication skills.
Each intervention is tailored to the individual’s needs and often used in combination to address the
various challenges associated with ASD. The effectiveness of these treatments can vary widely, and
ongoing adaptation and monitoring are essential to meet the evolving needs of individuals with ASD
as they grow and their environments change.
ADHD
DSM-5-TR Diagnostic Criteria for ADHD
1. Symptom Patterns
 Inattention: The individual exhibits at least six of the following symptoms (or five for
individuals 17 years and older) for at least six months to a degree that is inconsistent with
developmental level and negatively impacts social and academic/occupational activities:
 Often fails to give close attention to details or makes careless mistakes in schoolwork,
work, or other activities.
 Often has difficulty sustaining attention in tasks or play activities.
 Often does not seem to listen when spoken to directly.
 Often does not follow through on instructions and fails to finish schoolwork, chores,
or duties in the workplace.
 Often has difficulty organizing tasks and activities.
 Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental
effort.
 Often loses things necessary for tasks and activities.
 Is often easily distracted by extraneous stimuli.
 Is often forgetful in daily activities.
 Hyperactivity and Impulsivity: The individual exhibits at least six of the following
symptoms (or five for individuals 17 years and older) for at least six months to a degree that
is disruptive and inappropriate for developmental level:
 Often fidgets with or taps hands or feet, or squirms in seat.
 Often leaves seat in situations when remaining seated is expected.
 Often runs about or climbs in situations where it is not appropriate.
 Often unable to play or engage in leisure activities quietly.
 Is often "on the go," acting as if "driven by a motor."
 Often talks excessively.
 Often blurts out an answer before a question has been completed.
 Often has difficulty waiting their turn.
 Often interrupts or intrudes on others.
2. Age of Onset
 Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
3. Duration
 Several symptoms are present in at least two or more settings (e.g., at home, school, or work;
with friends or relatives; in other activities).
4. Impact
 There is clear evidence that the symptoms interfere with, or reduce the quality of, social,
academic, or occupational functioning.
5. Exclusion
 The symptoms do not occur exclusively during the course of schizophrenia or another
psychotic disorder and are not better explained by another mental disorder (e.g., mood
disorder, anxiety disorder, dissociative disorder, a personality disorder, a substance
intoxication or withdrawal).
The etiology of ADHD (Attention-Deficit/Hyperactivity Disorder) is multifactorial, meaning that
multiple factors contribute to its development. These factors can be broadly categorized into genetic,
environmental, neurological, and psychological components. Here's a detailed look at each:
1. Genetic Factors
ADHD has a strong hereditary component. Studies show that it tends to run in families, and the
heritability of ADHD is estimated to be about 70-80%, indicating that genetics play a significant role
in its development.
 Genetic Studies: Twin and family studies have consistently supported the genetic basis of
ADHD. Specific genes related to neurotransmitter systems have been implicated, including
those influencing dopamine (such as DRD4, DRD5, DAT1) and serotonin (such as 5-HTT).
 Gene-Environment Interactions: Genetic predispositions may interact with environmental
factors to increase the risk of developing ADHD.
2. Environmental Factors
Environmental influences can also play a crucial role in the onset and development of ADHD.
 Prenatal Exposure: Exposure to nicotine, alcohol, or drugs during pregnancy is associated
with a higher risk of ADHD in offspring. Maternal stress and poor nutrition during pregnancy
have also been linked to higher rates of ADHD.
 Perinatal Factors: Low birth weight, prematurity, and complications during delivery may
increase the risk of developing ADHD.
 Toxic Exposures: Early childhood exposure to environmental toxins, such as lead, can
adversely affect brain development and function, potentially leading to ADHD symptoms.
 Psychosocial Factors: High levels of familial discord, low socioeconomic status, and
inconsistent parenting styles may contribute to the manifestation of ADHD symptoms.
3. Neurological Factors
ADHD is associated with several differences in brain structure and function. Neuroimaging studies
have highlighted several key areas:
 Brain Structure: Research has shown differences in the size and activation of certain brain
regions in individuals with ADHD, including the prefrontal cortex (responsible for executive
functions such as decision-making and impulse control), the basal ganglia, and the
cerebellum.
  Neurotransmitter Systems: Dysregulation in neurotransmitter systems, particularly those
involving dopamine and norepinephrine, is a central aspect of ADHD. These
neurotransmitters play critical roles in regulating attention, impulsivity, and motor activity.
4. Psychological Factors
Psychological and developmental factors also contribute to the complexity of ADHD.
 Cognitive Impairments: Deficits in executive functions (e.g., working memory, cognitive
flexibility, planning, inhibition) are commonly observed in individuals with ADHD. These
impairments can affect academic, occupational, and social functioning.
 Behavioral Theories: Some theories suggest that ADHD behaviors are reinforced over time.
For example, children with ADHD may receive more attention for hyperactive or inattentive
behaviors, which can inadvertently reinforce these behaviors.
The treatment of ADHD (Attention-Deficit/Hyperactivity Disorder) involves a combination of
interventions tailored to meet the unique needs of each individual. Effective management usually
includes a mix of medication, behavioral therapies, educational support, and lifestyle modifications.
Here’s a detailed look at these treatment modalities:
1. Medication
Medication is often a primary treatment for ADHD, particularly for its core symptoms of
hyperactivity, impulsivity, and inattention.
 Stimulants: These are the most commonly prescribed medications and include
methylphenidate and amphetamines, as detailed previously. They help improve attention and
focus and control behavior.
 Non-stimulants: For patients who do not respond well to stimulants or experience significant
side effects, non-stimulant medications like atomoxetine (Strattera), guanfacine (Intuniv), and
clonidine (Kapvay) are options. These may take longer to show effects but can be effective in
improving attention and reducing impulsivity.
2. Behavioral Therapies
Behavioral interventions are critical, especially for children, as they help improve behavior, self-
control, and self-esteem.
 Behavior Modification: Involves reinforcing desired behaviors through rewards and
consequences and is often effective in both home and school settings.
 Cognitive Behavioral Therapy (CBT): Helps in managing challenging behaviors, improving
emotion regulation, and developing coping strategies. It’s particularly useful for older
children, adolescents, and adults with ADHD.
 Parent Training and Family Therapy: Educates parents and family members on how to
handle behavioral problems and create an environment that supports their child’s
development.
3. Educational Support and Interventions
School-based programs are essential for children with ADHD to succeed academically.
 Individualized Education Programs (IEPs): These are tailored plans in schools in the U.S.
that outline specific educational interventions.
  504 Plans: Provide accommodations that might include extra time on tests, assistance with
note-taking, assignments broken into smaller chunks, and preferential seating.
4. Lifestyle and Dietary Modifications
Changes in lifestyle can also support other treatment strategies:
 Diet: While no specific diet cures ADHD, a healthy, balanced diet can reduce symptoms.
Some studies suggest that omega-3 supplements might help to a small degree.
 Exercise: Regular physical activity can help improve concentration, decrease anxiety and
depression, and stimulate the brain.
 Sleep: Ensuring sufficient and quality sleep is crucial as poor sleep can exacerbate symptoms.
5. Psychoeducation
Educating individuals with ADHD and their families about the disorder can help manage expectations
and improve adherence to treatment plans.
 Understanding ADHD: Knowing what ADHD is and how it affects learning and behavior
can empower patients and families to seek the most appropriate interventions.
6. Complementary Therapies
Some people find complementary therapies helpful, although these should not replace mainstream
treatments.
 Mindfulness and Meditation: Can improve concentration and stress management.
 Biofeedback: Uses electronic devices to help people gain control over bodily functions, such
as heart rate variability, which may improve attention and reduce impulsivity.


Conduct Disorder
Diagnostic Criteria for Conduct Disorder (DSM-5-TR)

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-
appropriate societal norms or rules are violated, as manifested by the presence of at least three of the
following 15 criteria in the past 12 months, with at least one criterion present in the last 6 months:

1. Aggression to People and Animals:

 Often bullies, threatens, or intimidates others.

 Often initiates physical fights.

 Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken
bottle, knife, gun).

 Has been physically cruel to people.

 Has been physically cruel to animals.

 Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed
robbery).

 Has forced someone into sexual activity.

 2. Destruction of Property:

 Has deliberately engaged in fire setting with the intention of causing serious damage.

 Has deliberately destroyed others' property (other than by fire setting).

3. Deceitfulness or Theft:

 Has broken into someone else's house, building, or car.

 Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others).

 Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without
breaking and entering).

4. Serious Violations of Rules:

 Often stays out at night despite parental prohibitions, beginning before age 13 years.

 Has run away from home overnight at least twice while living in parental or parental surrogate
home (or once without returning for a lengthy period).

 Is often truant from school, beginning before age 13 years.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or

occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Specifiers:

 Severity: Based on the number of conduct problems and the effect of these problems on others: mild,
moderate, or severe.

 Onset Type: Childhood-Onset Type (before age 10 years) and Adolescent-Onset Type (no symptom
criteria prior to age 10 years).

 With Limited Prosocial Emotions: This specifier is used if the individual displays at least two of the
following characteristics persistently over at least 12 months and in multiple relationships or settings:

 Lack of remorse or guilt.

 Callous—lack of empathy.

 Unconcerned about performance.

 Shallow or deficient affect.

Key Considerations:

 Assessment should differentiate between childhood and adolescent-onset types, as they may have
different implications for prognosis and treatment.

 Important to evaluate for comorbid conditions such as ADHD, mood disorders, anxiety disorders, and
substance use disorders.

The etiology of Conduct Disorder (CD) is multifactorial, involving a complex interplay of genetic, biological,
psychological, and social factors. Understanding these factors is crucial for counseling psychology students, as it
helps in formulating effective intervention and management strategies. Here’s a detailed explanation of these
etiological components:

1. Genetic Factors:
  Heritability: Studies suggest that CD has a significant heritable component. Family, twin, and
adoption studies indicate that children of parents with a history of antisocial behaviors or CD are at
higher risk of developing the disorder themselves.

 Genetic Dispositions: Specific genes have been linked to traits associated with CD, such as aggression
and impulsivity. The interaction between these genetic factors and environmental influences plays a
critical role in the development of CD.

2. Neurobiological Factors:

 Brain Structure and Functioning: Research indicates abnormalities in certain brain areas involved in
emotion regulation, moral reasoning, and impulse control, such as the prefrontal cortex and the
amygdala. These abnormalities may contribute to the impulsivity, aggression, and emotional
dysregulation observed in CD.

 Neurotransmitters: Imbalances in neurotransmitters like serotonin, dopamine, and noradrenaline are

also associated with aggressive behavior and might contribute to the pathology of CD.

3. Psychological Factors:

 Cognitive Processing: Individuals with CD often exhibit cognitive distortions, such as misinterpreting
others' behaviors as hostile, which can lead to aggressive responses. They may also have a reduced
ability to recognize and process emotions accurately.

 Personality Traits: Traits such as impulsivity, aggression, and a lack of empathy are strongly
associated with CD. These traits can exacerbate conflict and reduce the effectiveness of social or
behavioral constraints.

4. Social and Environmental Factors:

 Family Environment: Several aspects of family life can influence the development of CD, including:

 Parenting Style: Harsh, inconsistent discipline and lack of supervision or warmth are linked
to CD.

 Parental Psychopathology: Parents’ own history of antisocial behavior, substance abuse, or

mental health disorders can increase the risk.

 Family Conflict and Cohesion: High levels of family conflict and low levels of family
cohesion have been associated with CD.

 Peer Influences: Associations with deviant peers can reinforce antisocial behavior and provide a social
context that normalizes such behavior.

 Socioeconomic Status: Lower socioeconomic status and associated stressors (like overcrowding,
community violence, and limited resources) have been correlated with higher rates of CD.

 Cultural and Community Factors: Community violence, social norms condoning aggressive
behaviors, and lack of community resources (schools, recreational facilities) influence the prevalence
and manifestation of CD.

5. Developmental Factors:

 Early Life Experiences: Adverse childhood experiences, such as abuse, neglect, or trauma, are potent
risk factors for CD. These experiences can affect emotional regulation and attachment styles.

 Interaction of Developmental Trajectories: The interaction between early onset of behavioral

problems and subsequent parenting styles, peer relationships, and school experiences can influence the
development and persistence of CD.

Interventions for Conduct Disorder (CD) are designed to address the multifactorial nature of the disorder,
incorporating strategies tailored to the individual's symptoms, severity, developmental stage, and the presence of
co-occurring disorders. Effective intervention often requires a multi-modal approach involving the individual,
family, school, and community. Here’s a detailed explanation of the common intervention strategies:

1. Individual Therapies

 Cognitive-Behavioral Therapy (CBT): CBT is widely used to treat CD. It focuses on modifying the
cognitive distortions and maladaptive behaviors associated with the disorder. Techniques include
problem-solving skills, anger management, and social skills training. The therapy aims to improve
emotional regulation and reduce impulsivity and aggressive behaviors.

 Dialectical Behavior Therapy (DBT): This form of therapy is adapted for adolescents with CD,
especially those exhibiting self-harm behaviors. DBT focuses on mindfulness, emotion regulation,
distress tolerance, and interpersonal effectiveness skills.

 Psychodynamic Psychotherapy: Although less commonly used, this therapy can help uncover
underlying emotional conflicts that may be contributing to antisocial behavior, particularly in complex
cases with significant emotional issues.

. Family-Based Interventions

 Parent Management Training (PMT): PMT teaches parents effective parenting techniques that are
consistent and non-punitive. Parents learn to reinforce desirable behaviors through rewards and to use
non-harsh disciplinary measures for undesirable behaviors.

 Family Therapy: This involves working with the whole family to improve communication, solve
family problems, reduce conflicts, and enhance family cohesion. Structural family therapy and strategic
family therapy are common approaches.

 Multisystemic Therapy (MST): MST is an intensive family- and community-based treatment

program that addresses the multiple determinants of serious antisocial behavior in adolescents. It
focuses on the factors in the family, school, and community that contribute to the behavior.

. School-Based Interventions

 Special Education Programs: These programs can assist children with CD who may have learning
disabilities or other school-related difficulties. They often include behavior modification plans, which
help manage the behavior in a school setting.

 Social Skills Training: Schools can offer programs that focus on peer relationships, conflict resolution,
and appropriate social behaviors.

Peer Group Interventions

 Peer Group Interventions: It's beneficial to involve the peer group in the treatment process, as peers
can significantly influence behavior. Programs that foster pro-social peer interactions and reduce
contacts with deviant peers are important. Group therapies that focus on social skills and interpersonal
relationships can also be beneficial.

Legal and Community Resources

 Juvenile Justice Involvement: For some adolescents with severe CD, involvement with the juvenile
justice system may occur. Working closely with probation officers, social workers, and counselors who
specialize in juvenile behaviors can help integrate legal interventions with therapeutic strategies.

 Community Support Services: Linking families and individuals with community resources can
provide additional support. This includes access to recreational centers, mental health services, and
substance abuse programs where applicable.

. Crisis Management
 Emergency Interventions: In cases where there is a risk of harm to the individual or others,
emergency interventions may be necessary. This can include crisis hotlines, emergency counseling
sessions, or, in extreme cases, hospitalization to manage the crisis safely.

 Safety Planning: For individuals who exhibit violent or severely disruptive behaviors, developing a
safety plan with the family and school is crucial. This plan should outline steps to take in response to
crisis situations to ensure the safety of all involved.