CLP 7136-0002 Child Psychopathology Fall, 2015 Instructor: Mark D. Rapport, Ph.D. Professor, Clinical Child Psychology APA Fellow Director, Children’s Learning Clinic-IV Office hours: by appointment (note: I am usually in the CLC-IV, suite 140) Meeting place/day/time: Psychology Building, room 301C; Wednesdays 9:00-11:50 a.m. Cell Phone: (407) 587-5396 (call or text message) e-mail: mdrapport@gmail.com Required Readings: Required readings for the class are comprised of the following: (a) an updated and advanced textbook on child and adolescent psychopathology; (b) select journal articles for each of the topics covered in the course; and (c) a special topic book written by a professor who provides a vivid personal account of her life as she developed and coped with schizophrenia. Assigned research papers provide updated, integrated coverage regarding the theoretical models, epidemiology, genetics, primary/secondary symptoms, and assessment of the mostly widely occurring clinical child disorders. Select papers concerning the primary treatment of particular disorders will be assigned to the extent that they are relevant to understanding the etiological nature of the disorder. [Disclaimer: I do not typically require textbooks for doctoral level classes; however, several students who enroll in the course each year have not completed an undergraduate course in child psychopathology and requested that I include an advanced textbook on the topic to provide broad background information about the multiple clinical child disorders]. Required Texts and Publications: 1. Title: Introduction to Abnormal Child and Adolescent Psychology, 2nd edition (2014) Author: Robert Weis Publisher: Sage Publications ISBN: 9781452225258 (Hardcover) $135.00**[there should be ample ‘used’ copies available from the more popular online companies at a significantly reduced cost…I just located one for $58.00] or eTextbook: Introduction to Abnormal Child and Adolescent Psychology, Second Edition | ISBN: 9781452225258 2. Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5TM), 2013 Author: American Psychiatric Association ISBN 978-0-89042-555-8 (991 pages, softcover) (list price = $149.00***I found a used/new softcopy online for under $40.00) 3. Title: The Center Cannot Hold Author: Elyn R. Saks Publisher: Hyperion ISBN: 13: 978-0-7394-9774-6 [book can be ordered from Amazon.com] 4. Topical Journal articles [see weekly assignments, below] Course Description: This course will cover the major psychological disorders of childhood, including issues of prevalence, classification, phenomenology, course, comorbidity, major etiological theories, and assessment. Lectures and discussions will focus on examining the current state of research on childhood psychopathology, and will highlight a developmental psychopathology perspective wherever appropriate. Course objectives include: Understanding diagnostic schemas including the DSM and alternative models of psychopathology Understanding the etiology, correlates, comorbidities and developmental course of childhood disorders Understanding the developmental trajectory and factors that influence the diagnosis and behavioral manifestation of childhood disorders Understanding the neurobiological and environmental factors that impact the development, maintenance and course of childhood disorders Course Requirements: Class Attendance and Participation. Your [timely] attendance at each class meeting is expected. Arriving after the class has begun is inappropriate and considered disrespectful of other students in the class. Please turn off your cell phone and your computer during active class time. You will have sufficient time to check messages during the break. Final Exam: (50% of grade): The exam will consist of short to mid-range essay questions, short answer questions, theoretical diagrams of clinical disorders, and completion of clinical disorder information sheets. In-class oral presentations (40% of grade): All students will select or be assigned two DSM-5 disorder categories to evaluate and summarize for the class based on the newly released DSM-5 (2013). These presentations will occur at the beginning of each class and correspond with the clinical disorder(s) discussed during that particular class meeting. The presentation will summarize current theoretical models associated with a particular child clinical disorder, including a visual schematic of the DSM-IV implied clinical model and an alternative model based on the empirical literature reviewed (see disorders marked by an asterisk immediately below). Presentations should begin with a very brief review of the core diagnostic and clinical features of the disorder (everyone will have already reviewed these criteria—cover only the broad categories not the individual symptoms within the categories—include the symptoms on the PP slides), and succinctly review suspected genetic/neurobiological (e.g., structural abnormalities, neurotransmitter deficiencies/excesses) underpinnings of the disorder, and how these factors interact with children’s behavior and/or cognitive performance. The most critical issue to keep in mind is to ‘integrate’ rather than departmentalize this information (e.g., genetic influences may contribute to a child’s inattentiveness by several factors such as immature brain development coupled with under aroused frontal/prefrontal regions, which in turn, contributes to a child’s ability to sustain attention, learn, and interact with others successfully). Your power point presentation should be formatted in the following manner: o Succinct review of the DSM-5 symptom categories (unless there are none) and core features of the disorder using a schematic diagram of the disorder and hypothesized mechanisms and processes that may account for the symptoms (based on the DSM-5, not necessarily current research findings). Be certain to include information pertaining to the typical ‘onset’, ‘course’, and ‘duration’ of the disorder. The schematic should be in drawn using dark colors (e.g., dark blue) and ‘bold’ font to facilitate viewing from the overhead projector. o DSM-5 Childhood Disorders: [note: briefly note all disorders within the overall category before proceeding to the specific disorder you are covering in your presentation] o Succinct review of published meta-analytic reviews and/or seminal papers regarding the genetic/neurobiological underpinnings of the disorder, the contribution/explanation of how these mechanisms/processes influence behavior and cognition, and in turn, how they may influence peripheral or secondary symptoms of the disorder. o ****Email me (mdrapport@gmail.com) 3 papers that you are recommending everyone in the class read 1-week prior to your presentation…I will review the papers and either approve them or offer additional recommendations. These papers will subsequently be placed into a shared google document so that all class members can access them easily. o Presentation of a schematic diagram based on the aforementioned information that challenges the DSM-5 and differs from the initial schematic diagram of the clinical disorder. I will demonstrate an example of how the DSM-5 vs Evidencedbased schematic should look during one of our earlier class meetings. o Grading: [50 points possible for each presentation =100 total points toward grade] Clarity, organization, & succinctness of oral presentation = 15 points Systematic & comprehensive literature review = 20 points Schematic diagrams of the disorder x 2 = 10 points Appropriate formatting (bold font, dark colors, bullets) and appearance = 5 points Weekly submitted questions for classroom discussion (5%) + The Center Cannot Hold writing assignment (5% of grade). One typed, double-spaced, Times New Roman 12point font question for each journal article assigned for the week…immediately below the question, write a brief answer to the question. Each question will count for 5 points, with scoring reflecting the thoughtfulness of the question (note: this is admittedly subjective; however, I expect everyone to earn the maximum number of points each week for coming up with interesting questions and answers for in-class discussion). Total points for questions at the end of the course (5%), coupled with the Center Cannot Hold assignment (5%) will be transformed to reflect 10% of your grade. Center Cannot Hold Assignment: Write a brief (< 4 pages, double spaced using Times New Roman 12 point font) that covers/summarizes your opinion of this true story to include the following: 1. Describe the onset and course of the illness. 2. What role did her parents, early involvement with drugs, and friends play in the disorder? 3. Did psychodynamic therapy help her recover, and if so, by what mechanism(s)? 4. What were the most important things you discovered by reading this story? Final Grade Calculation: Exam: .5 x 100 possible points = 50 points maximum toward final grade Presentations: .4 x 100 possible points = 40 point maximum toward final grade Weekly submitted questions + Center Cannot Hold written assignment: .1 x total possible points = 10 point maximum toward final grade Clinical Disorders to be selected for Class Presentation Neurodevelopmental Disorders Attention Deficit Hyperactivity Disorder (ADHD)** MDR will cover Autistic Spectrum Disorders (1) Tourette’s Disorder (not available for presentation) Schizophrenia Spectrum Disorders (2) Bipolar and Related Disorders (3) Depressive Disorders Disruptive Mood Dysregulation Disorder (4)**DMDD & MDD present on same day** Major Depressive Disorder (5)**DMDD & MDD present on same day** Dysthymia (not available for presentation) Anxiety Disorders Separation Anxiety Disorder (6) Selective Mutism (select this topic or the one below it—see new categorization)(5) Social Anxiety Disorder Generalized Anxiety Disorder (7) Specific Phobias (8) Obsessive-Compulsive and Related Disorders (9) Disruptive, Impulse Control and Conduct Disorders Oppositional Defiant Disorder (ODD) (10)**CD and ODD present on same day** Conduct Disorder (CD) (11)** CD and ODD present on same day** Elimination Disorders-Diurnal & Nocturnal Enuresis (12) Class Presentations and Dates: Date Clinical Disorder David Brush (2) David Brush (9) Manuel Herrera Legon (6) Manuel Herrera Legon (11) Nicholas James (1) Nicholas James (5) Krystal Morrison (7) Krystal Morrison (10) Jennifer Scheurich (3) Jennifer Scheurich (12) J’Nelle Stephenson (4) J’Nelle Stephenson (8) 10 Presentation Dates: Sept 23rd, 30th; October 7th, 14th, 21st, 28th; Oct 4th, 18th, 25th; Dec 2nd DISCLAIMER. Elements of this syllabus are subject to change per the discretion of the instructor due to the rapid publication of new studies in the field. Students will be notified immediately of any changes made to the syllabus. Academic Dishonesty: In accord with University Policy, academic dishonesty, including cheating, plagiarism, misrepresentation, second-hand papers retrieved via internet or other sources, or other dishonest practices will result in an “F” for the course. Policy regarding attendance. Your timely attendance in class is expected unless you are ill. Policy regarding missed exams and late assignments. Excused absences from exams may be granted by the professor in cases of medical or other emergencies. Proper written documentation will be necessary, and granting of make-up exams is solely at the discretion of the professor. Late assignments will be penalized 20% for each day following the deadline (20% for 0-24 hours after the deadline, 40% for 25-48 hours after the deadline, etc.). Americans with Disabilities Act. I will make every effort to accommodate students who are registered with the Disability Support Services (DSS) Office. It is incumbent upon the student to request DSS to provide the necessary documentation no later than the end of the first week of class. COURSE SCHEDULE OVERVIEW Aug 26th Introduction to Child Psychopathology: Diagnosis and nosological classification of childhood disorders, defining a clinical disorder, externalizing/internalizing disorders, epidemiology, sensitivity/specificity/PPP/NPP, defining therapeutic change, differential diagnosis, cultural/gender differences. Assigned Readings: Chapter 1: The Science and Practice of Abnormal Child Psychology [Text: Introduction to Abnormal Child and Adolescent Psychology] Coghill, D., & Sonuga-Barke, E.J.S. (2012; on-line, early release). Annual Research Review: Categories versus dimensions in the classification and conceptualization of child and adolescent mental disorders: implications of recent empirical study. Journal of Child Psychology and Psychiatry, doi:10.1111/j.14697610.2011.02511.x Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593-602. Stein, D.J., Phillips, K.A., Bolton, D., Fulford, K.W., Sadler, J.D., & Kendler, K.S. (2010). What is a Mental/Psychiatric Disorder? From DSM-IV to DSM-V. Psychological Medicine, 40, 1759-1765. Rapee, R.M., Bogels, S.M., van der Sluis, C., Craske, M.G., & Ollendick, T. (2012). Annual Research Review: Conceptualizing functional impairment in children and adolescents. Journal of Child Psychology and Psychiatry 53, 454– 468. Sept 2nd Developmental psychopathology, mediators and moderators, equifinality and multifinality, differential diagnosis (including lab based assessments), standardized rating scales (use, advantages/disadvantages), interpreting metaanalytic review papers. Assigned Readings: Chapter 2: The Causes of Child Psychopathology Chapter 3: Assessing and Diagnosing Children’s Problems [Text: Introduction to Abnormal Child and Adolescent Psychology] Truax, P., & Jacobson, N.S. (1991). Clinical significance: a statistic approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19. Roth, T.L., & Sweatt, J.D. (2011). Annual Research Review: Epigenetic mechanisms and environmental shaping of the brain during sensitive periods of development. Journal of Child Psychology and Psychiatry 52:4, pp 398–408 doi:10.1111/j.1469-7610.2010.02282.x Miller, G.A., & Chapman, J. P. (2001). Misunderstanding analysis of covariance. Journal of Abnormal Psychology, 110, 40-48. Externalizing Disorders Sept 9 th Attention-Deficit/Hyperactivity Disorder: ADHD [Part 1] Assigned Readings: DSM-5 ADHD section Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65–94. Castellanos FX, Tannock R. Neuroscience of attention deficit/hyperactivity disorder: the search for endophenotypes. Nature Review Neuroscience 3: 617-628. Rapport, M.D., Chung, K., & Shore, G. (2001). A conceptual model of child psychopathology: Implications for understanding attention deficit hyperactivity disorder and treatment efficacy. Journal of Clinical Child Psychology, 30, 48-58. Rapport, M.D., Kofler, M., Alderson, M., & Raiker, J. (2008). AttentionDeficit/Hyperactivity Disorder. In M. Hersen & D. Reitman (Eds), Handbook of Psychological Assessment, Case Conceptualization and Treatment, Volume 2: Children and Adolescents. (pp. 349-404). NJ: Wiley & Sons. Rapport, M.D. Scanlan, S.W. & Denney, C.B. (1999). Attentiondeficit/hyperactivity disorder and scholastic achievement: A model of dual developmental pathways. Journal of Child Psychology and Psychiatry, 40, 11691183. Linda J. Porrino, PhD; Judith L. Rapoport, MD; David Behar, MD; Walter Sceery, MSW; Deborah R. Ismond, MA; William E. Bunney, Jr, MD (1983). A Naturalistic Assessment of the Motor Activity of Hyperactive Boys I. Comparison With Normal Controls. Archives of General Psychiatry, 40, 681-687. Sept 16th ADHD [Part 2] Shaw et al., 2007, NIMH brain development video Assigned Readings: Shaw, P. Eckstrand, K. Sharp, W. Blumenthal, J. Lerch, J. Greenstein, D. Clasen, L. Evans, A. Giedd, J. & Rapoport, J. L. (2007). Attention-deficit/ hyperactivity disorder is characterized by a delay in cortical maturation, Proceedings of the National Academy of Sciences of the United States of America (PNAS), 104, (49), pp. 19649–19654. Dickstein, S. G., Bannon, K., Castellanos, F. X., & Milham, M. P. (2006). The neural correlates of attention deficit hyperactivity disorder. an ALE meta-analysis. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 47, 1051– 1062. doi:10.1111/j.1469-7610.2006.01671.x. Alderson, R.M., Rapport, M.D., & Kofler, M.J. (2007). Attention-Deficit/ Hyperactivity Disorder and behavioral inhibition: A meta-analytic review of the Stop-signal paradigm. Journal of Abnormal Child Psychology, 35, 745-758 Rapport, M.D., Alderson, R.M., Kofler, M.J., Sarver, D.E., Bolden, J., & Sims, V. (2008). Working memory deficit in boys with attention-deficit/hyperactivity disorder (ADHD): The contribution of the central executive and subsystem processes. Journal of Abnormal Child Psychology, 36, 825–837. Rapport, M.D., Bolden, J., Kofler, M.J., Sarver, D.E., Raiker, J.S., Alderson, R.M. (2009). Hyperactivity in Boys with Attention-Deficit/Hyperactivity Disorder (ADHD): A Ubiquitous Core Symptom or Manifestation of Working Memory Deficits? Journal of Abnormal Child Psychology, 37, 521-534. Kofler, M.J., Rapport, M.D., Bolden, J., Sarver, D.E., & Raiker, J.S. (2010). ADHD and Working Memory: The Impact of Central Executive Deficits and Exceeding Storage/Rehearsal Capacity on Observed Inattentive Behavior. Journal of Abnormal Child Psychology. 38, 149-161. Sept 23rd Assigned Readings: ODD and Conduct Disorder [Part 1] Assigned Readings: Chapter 9: Conduct Problems in Children and Adolescents [Text: Introduction to Abnormal Child and Adolescent Psychology] DSM-5: ODD and CD Loeber, R., Burke, J., Lahey, B., Winters, A., & Zera, M. (2000). Oppositional defiant and conduct disorder: A review of the past 10 years, Part 1. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1468-1484. Steiner, H., & Remsing, L, (2007). Practice parameters for the assessment and treatment of children and adolescents with oppositional defiant disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 126-141. Mills-Koonce, W.R., Wagner, N.J., Willoughby, M.T., Stifter, C., Blair, C., Granger, D.A., & The Family Life Project Key Investigators. (2014). Greater fear reactivity and psychophysiological hyperactivity among infants with later conduct problems and callous-unemotional traits. Journal of Child Psychology and Pychiatry, doi:10.1111/jcpp.12289 (early online version). Willoughby, M.T., & Mills-Koonce, W.R., Gottfredson, N.C., & Wagner, N.J. (2014). Measuring Callous Unemotional Behaviors in Early Childhood: Factor Structure and the Prediction of Stable Aggression in Middle Childhood. Journal of Psychopathology and Behavioral Assessment, 36, 30-42. DOI 10.1007/s10862013-9379-9 Sept 30th ODD and Conduct Disorder [Part 2] Assigned Readings: Frick, P. (2012). Developmental Pathways to Conduct Disorder: Implications for Future Directions in Research, Assessment, and Treatment. Journal of Clinical Child & Adolescent Psychology, 41, 378–389. Fontaine, N.MG., Rijsdijk, F.V., McCrory, E.J.P., & Viding, E. (2010). Etiology of different developmental trajectories of callous-unemotional traits. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 656-664. Rapport, M.D., LaFond, S.V., & Sivo, S.A. (2009). Unidimensionality and Developmental Trajectory of Aggressive Behavior in Clinically-Referred Boys: A Rasch Analysis. Journal of Psychopathology and Behavioral Assessment,31, 309319. Internalizing Disorders Oct 7th Mood Disorders [Part 1] Assigned Readings: Chapter 11: Depressive Disorders in Children and Adolescents [Text: Introduction to Abnormal Child and Adolescent Psychology] DSM-5: Mood Disorders sections Carlson, G.A., & Cantwell, D.P. (1980). Unmasking masked depression in children and adolescents. American Journal of Psychiatry, 137, 445-449. Cole, D.A., Peeke, L.G., Martin, J.M., Truglio, R., & Seroczynski, A.D. (1998). A Longitudinal Look at the Relation Between Depression and Anxiety in Children and Adolescents. Journal of Consulting and Clinical Psychology, 66, 451-460. Practice Parameters for the assessment and treatment of children and adolescents with depressive disorders, (2007). Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1503-1526. Oct 14th Mood Disorders [Part 2] Assigned Readings: Chapter 12: Bipolar Disorders in Children and Adolescents [Text: Introduction to Abnormal Child and Adolescent Psychology] DSM-5: Bipolar Disorder sections Carlson, G.A., & Meyer, S.E. (2006). Phenomenology and diagnosis of bipolar disorder in children, adolescents, and adults: Complexities and developmental issues. Development and Psychopathology, 18, 939-969. Baroni, A., Lunsford, J.R., Luckenbaugh, D.A., Towbin, K.E., & Leibenluft, E. (2009). Practitioner Review: The assessment of bipolar disorder in children and adolescents. Journal of Child Psychology and Psychiatry, 50, 203-215. Youngstrom, E.A., & Duax, J. (2005). Evidence-Based Assessment of Pediatric Bipolar Disorder, Part I: Base Rate and Family History. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 712-717. Oct 21st Anxiety Disorders [Part 1] Assigned Readings: Chapter 13: Anxiety Disorders in Children and Adolescents [Text: Introduction to Abnormal Child and Adolescent Psychology] DSM-5: Phobia, Social Phobia, Separation Anxiety, Generalized Anxiety Disorder sections Kagan, J., Reznick, J.S., and Snidman, N. (1987). The Physiology and Psychology of Behavioral Inhibition in Children. Child Development, 58, 14591473. Mineka, S., & Zinbarg, R. (2006). A Contemporary Learning Theory Perspective on the Etiology of Anxiety Disorders: It’s Not What You Thought It Was. American Psychologist, 51, 10-26. Oct 28th Anxiety Disorders [Part 2] Assigned Readings: DSM-IV: Obsessive Compulsive Disorder, Tourette’s Disorder, Post Traumatic Distress Disorder sections Schwartz, C.E., Snidman, N., & Kagan, J. (1999). Adolescent Social Anxiety as an Outcome of Inhibited Temperament in Childhood. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 1008-1015. Hale, W.W., Raaijmakers, Q.A., Muris, P., van Hoof, A., Meeus, W.H.J. (2009). One factor or two parallel processes? Comorbidity and development of adolescent anxiety and depressive disorder symptoms. Journal of Child Psychology and Psychiatry, 50, 1218-1226. Miers, A.C., Blöte, A.W., de Rooij, M., Bokhorst, C.L., & Westenbert, P.M. (2013). Trajectories of Social Anxiety during Adolescence and Relations with Cognition, Social Competence, and Temperament. Journal of Abnormal Child Psychology, 41, 97–110. DOI 10.1007/s10802-012-9651-6 Clauss, J.A., & Blackford, J.U. (2012). Behavioral Inhibition and Risk for Developing Social Anxiety Disorder: A Meta-Analytic Study. Journal of the American Academy of Child & Adolescent Psychiatry, 51, 1066-1075 (early release). Developmental Spectrum Disorders Nov 4th Pervasive Developmental Disorders, Autism Assigned Readings: Chapter 6: Autism and Other Pervasive Developmental Disorders [Text: Introduction to Abnormal Child and Adolescent Psychology] DSM-5: Autism and Related Developmental Spectrum Disorders sections Tanguay, P.E. (2000). Pervasive Developmental Disorders: A 10-Year Review. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 10791095. Lord, C., & Jones, R.M. (2012). Annual research review: Re-thinking the classification of autism spectrum disorders. Journal of Child Psychology and Psychiatry, 53, 490-509. Nov 11th Veterans Day Holiday—no class Nov 18th Early On-set Child Schizophrenia Assigned Readings: DSM-5: Schizophrenia Section Asarnow, J.R., & Tompson, M.C. (1999). Childhood-onset Schizophrenia: A follow-up study. European Child & Adolescent Psychiatry, 8, I09-I12. Gilmore, J.H. (2010). Understanding what causes schizophrenia: A developmental perspective. American Journal of Psychiatry, 167, 8-12. Waters, F., Allen, P., Aleman, A., Fernyhough, C., Woodward,T.S., Badcock, J.C., Barkus, E., Johns, L., Varese, F., Menon, M., Vercammen, A., & Larøi, F. (2012). Auditory Hallucinations in Schizophrenia and Nonschizophrenia Populations: A Review and Integrated Model of Cognitive Mechanisms. Schizophrenia Bulletin, 38, 683–692. Nov 25th Elimination Disorders, Sleep Disorders, and Child Abuse/Neglect Assigned Readings: Chapter 15: Child Abuse and Neglect [Text: Introduction to Abnormal Child and Adolescent Psychology] DSM-5: Elimination disorder (enuresis, encopresis) and sleep disorder sections Alfano, C.A., Zakem, A.H., Costa, N.M., Taylor, L.K., Weems, C.F. (2009). Sleep problems and their relation to cognitive factors, anxiety, and depressive symptoms in children and adolescents. Depression and Anxiety, 26, 503-512. Dec 2nd Mental Retardation/Learning Disabilities/Academic Problems/ Elimination Disorders Assigned Readings: Chapter 5: Mental Retardation and Intellectual Disabilities Chapter 7: Learning Disorders and Academic Problems [Text: Introduction to Abnormal Child and Adolescent Psychology] DSM-5: Intellectual Disabilities and Specific Learning Disorders sections Additional Updated Readings—dyslexia and reading disorder Stanovich, K.E. (1988). Explaining the differences between the dyslexic and the garden-variety poor reader: The phonological-core variable-difference model. Journal of Learning Disability, 21, 590-604. Dekker, M.C., & Koot, H.M. (2003). DSM-IV Disorders in Children with Borderline to Moderate Intellectual Disability. I: Prevalence and Impact. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 915-922. Dec 11th (Friday) Final Exam [scheduled by UCF for 7:00-9:50 a.m.]**we can discuss whether the class would prefer sitting for the exam on Wednesday at 9:00 a.m. as an alternative**