chapter 13

Question 1

Normal vs Abnormal Behavior

Answer 1

Normal vs Abnormal: Depends on age and cultural background

Key: deviation from development and normative standards

Setting: home, school, generalized, etc

Question 2

Neurodevelopmental disorders

Answer 2

A category of mental disorders in the DSM-5 affecting children and adolescents and that involve impaired brain functioning or development

⅕ American children and young adults develops a psychological disorder
- Fail to get the treatment they need

Question 3

types of Neurodevelopmental disorders

Answer 3

Autism spectrum disorder
Intellectual disability
Specific learning disorder
Communication disorders
attention-deficit/hyperactivity disorder

Question 4

Autism spectrum disorder (ASD)

Answer 4

A developmental disorder characterized by significant deficits in communication and social interaction, as well as development of restricted or fixed interests and repetitive behaviors

Chronic, lifelong condition
Prevalence has been rising steadily for several decades

5x as common in boys as girls

DSM
Asperger’s disorder was a distinct diagnosis in the previous edition of the DSM but is not classified in the DSM-5 as a form of autism spectrum disorder

Question 5

asperger’s

Answer 5

A pattern of behavior characterized by social awkwardness and stereotyped or repetitive behaviors but without the significant language or cognitive deficits associated with more severe forms of autism spectrum disorder

Question 6

criteria of Autism spectrum disorder (ASD)

Answer 6

A) Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of the following, currently, or by history
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth to initiate or respond to social interactions
2. Deficits in nonverbal communicative behaviors used for social interaction, randing, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers

B) Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently, or by history
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat
same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or
perseverative interests).
4. Hyper- or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

C) Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

D) Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E) These disturbances are not better explained by intellectual developmental disorder (intellectual disability) or global developmental delay. Intellectual developmental disorder and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual developmental disorder, social communication should be below that expected for general developmental level.

Question 7

Severity levels of ASD

Answer 7

Level 1 - Requiring Support
Level 2 - Requiring Substantial Support
Level 3 - Requiring Very Substantial Support

Question 8

specify if ASD

Answer 8

With or without accompanying intellectual impairment

With or without accompanying language impairment

Associated with a known genetic or other medical condition or environmental factor

Associated with a neurodevelopmental, mental, or behavioral problem With catatonia

Question 9

features of ASD

Answer 9

Most poignant feature: aloneness

mute

echolalia (parroting back what the child has heard in a high pitched monotone)

Nonverbal communication may also be impaired or absent

Interminably twirling, flapping the hands, rocking back and forth with the arms around the knees

Preservation of sameness

Lack a differentiated self-concept and sense of themselves

Question 10

Theoretical Perspectives on Autism

Answer 10

early

cognitive theory

genetic factors

brain abnormalities

environmental influences?

Question 11

Early and now discredited belief of ASD

Answer 11

Reaction to parents who were cold and detached – “emotional refrigerators”

Question 12

ASD cognitive theory

Answer 12

limited ability to process multiple stimuli at one time, aka slow stimuli association

• Difficulty integrating information from various senses
• Over or under sensitivity to stimulation, diminishing capacity to ‘make use’ of information

Question 13

ASD genetic factors

Answer 13

high twin concordance

Question 14

ASD brain abnormalities

Answer 14

abnormalities in neuron connection and loss of brain tissue

Question 15

Autism Spectrum Disorder - Treatment

Answer 15

Treatment depends on ‘severity’

Behavioral treatment
- Applied behavior analysis
- Operant conditioning to increase ability to attend to others, play with others, develop academic skills and keep from self mutilation
- Intensive, 1:1
- Imitation skills
- Apps

Question 16

Intellectual Disability (ID)

Answer 16

A generalized delay or impairment in the development of intellectual and adaptive abilities

Begins before the age of 18; improves over time (especially if they receive support, guidance, and enriched educational opportunities)

Affects conceptual, socialism and practical skills

DSM earlier - <70 IQ → DSM now doesn’t set any specific score

Causes
- Chromosomal and genetic disorders, infectious diseases, maternal alcohol use during pregnancy
- Exposure to an impoverished home environment

Question 17

criteria of ID

Answer 17

A) Intellectual developmental disorder (intellectual disability) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The following three criteria must be met:
1. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing.
2. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community.
3. Onset of intellectual and adaptive deficits during the developmental period.

Question 18

Intellectual Disability - Causes

Answer 18

chromosomal abnormalities
genetic disorders
prenatal factors

Question 19

ID - chromosomal abnormalities

Answer 19

Down syndrome - extra chromosome (47)
- A condition caused by the presence of an extra chromosome on the 21st pair and characterized by intellectual developmental disorder and various physical abnormalities
- 1/800 births
- Physical features: a round face, broad/flat nose, small/downward-sloping folds of skin at the inside corners of the eyes, protruding tongue, small hands, short fingers, disproportionately small arms and legs in relation to their bodies

Klinefelter - presence of an extra X chromosome

Turner syndrome - Single X instead of two X chromosomes

Question 20

ID - genetic disorders

Answer 20

Fragile X Syndrome
- An inherited form of intellectual developmental disorder caused by a mutated gene on the X chromosome
- 1.4/10,000 males and 0.9/10,000 females
- Effects: range from mild learning disorders to ID so profound that those affected can hardly speak or function

Phenylketonuria (PKU)
- A genetic disorder that prevents the metabolization of phenylpyruvic acid, leading to intellectual development disorder unless the diet is strictly controlled
- Caused by a recessive gene
- damaging CNS

Question 21

ID - prenatal factors

Answer 21

Maternal disease - Rubella (German measles) passed along from mother to child

Drugs

Maternal alcohol use - Ex: fetal alcohol syndrome

Question 22

Intellectual Disability - Interventions

Answer 22

Aimed at level of severity and geared to increase function

Psycho Education and skills work to assist in vocational skills and professional work
institution, home care and residential options for the most severe cases

Psychotherapy supporting their experiences as other

Question 23

Dyslexia

Answer 23

A learning disorder characterized by an impaired ability to read

Most common of all - 80%

Question 24

Learning disorder

Answer 24

A deficiency in a specific learning ability in the context of normal intelligence and exposure to learning opportunities

Chronic

Children - perform poorly in school

DSM-5
Applies a single diagnosis of specific learning disorder to encompass various types of learning disorders or disabilities involving significant deficits in skills involved in reading, writing, arithmetic, and math

Question 25

criteria of Learning disorder

Answer 25

A) Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties: 1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or slowly and hesitantly, frequently guesses words, has difficulty sounding out words). 2. Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings of what is read). 3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants). 4. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression of ideas lacks clarity). 5. Difficulties mastering number sense, number facts, or calculation (e.g., has poor understanding of numbers, their magnitude, and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures). 6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems).

Question 26

problems with --> learning disorder

Answer 26

Reading: Word reading accuracy Reading rate or fluency Reading comprehension Writing: Spelling accuracy Grammar and punctuation accuracy Clarity or organization of written expression Math: Number sense Memorization of arithmetic facts Accurate or fluent calculation Accurate math reasoning Executive Functioning: Organizing Planning Coordinating tasks

Question 27

Learning Disorders - Theories

Answer 27

Underlying brain dysfunctions related to, but not limited: - Processing - Decoding - Interpreting - Visual information - Auditory information - Deficits in prefrontal cortex Diagnosis and treatment depends on specific learning deficit

Question 28

Communication Disorders

Answer 28

A class of psychological disorders characterized by difficulties in understanding or using language

Question 29

Language disorder

Answer 29

A type of communication disorder involving impairments in the ability to produce or understand spoken language Slow vocab development, errors in tenses, difficulties recalling words

Question 30

criteria for language disorder

Answer 30

A) Persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other) due to deficits in comprehension or production that include the following: 1. Reduced vocabulary (word knowledge and use). 2. Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology). 3. Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation) B) Language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or occupational performance, individually or in any combination. C) Onset of symptoms is in the early developmental period. D) The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual developmental disorder (intellectual disability) or global developmental delay.

Question 31

problems with speech - language disorder

Answer 31

speech sound disorder childhood-onset fluency disorder social (pragmatic) communication disorder

Question 32

speech sound disorder

Answer 32

characterized by difficulties in articulating speech ini absence of oral speech mechanism or neurological impairment - Omit, substituting, or mispronouncing certain sounds

Question 33

childhood-onset fluency disorder (stuttering)

Answer 33

characterized by impaired fluency of speech Repetitions of sounds or syllables, prolonged sounds, interjections of inappropriate worlds, broken words, blocking of speech, word substitutions, excess of physical tension during emission, and repetition of monosyllabic whole worlds

Question 34

social (pragmatic) communication disorder

Answer 34

characterized by difficulties communicating with others in social contexts

Question 35

Treatment of communication disorders

Answer 35

Specialized speech and language therapy or with fluency training Psychological counseling

Question 36

Attention-deficit/hyperactivity disorder (ADHD)

Answer 36

A behavior disorder characterized by excessive motor activity and inability to focus one’s attention Most widely diagnosed psychological disorder in US children - 10% 2x more likely in boys than girls Symptoms tend to decline with age, may persist in milder forms into adolescence and adulthood

Question 37

criteria for Attention-deficit/hyperactivity disorder (ADHD)

Answer 37

A) A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2): Inattention and hyperactivity + impulsivity B) Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years. C) Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities). D) There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning. E) 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, personality disorder, substance intoxication or withdrawal).

Question 38

ADHD specify whether

Answer 38

Combined presentation Predominantly inattentive presentation Predominantly hyperactive/impulsive presentation in partial remission mild, mod, severe

Question 39

ADHD in partial remission

Answer 39

In partial remission: When full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment in social, academic, or occupational functioning.

Question 40

ADHD - mild, mod, sev

Answer 40

Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in social or occupational functioning. Moderate: Symptoms or functional impairment between “mild” and “severe” are present. Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning.

Question 41

inattention

Answer 41

1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities 2. Often has difficulty sustaining attention in tasks or play activities 3. Often does not seem to listen when spoken to directly 4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace 5. Often has difficulty organizing tasks and activities 6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort 7. Often loses things necessary for tasks or activities 8. Is often easily distracted by extraneous stimuli 9. Is often forgetful in daily activities

Question 42

hyperactivity

Answer 42

1. Often fidgets with or taps hands or feet or squirms in seat 2. Often leaves seat in situations when remaining seated is expected 3. Often runs about or climbs in situations where it is inappropriate 4. Often unable to play or engage in leisure activities quietly 5. Is often “on the go,” acting as if “driven by a motor” 6. Often talks excessively 7. Often blurts out an answer before a question has been completed 8. Often has difficulty waiting his or her turn 9. Often interrupts or intrudes on others

Question 43

AD/HD: Causes

Answer 43

Genetic High concordance rate in twins Environmental Maternal stress and smoking during pregnancy High family conflict, poor parenting skills, neglect Biological Breakdown of prefrontal cortex Genetic and Environmental factors = impacted executive functioning control in brain Trauma? Mirroring of trauma symptoms

Question 44

AD/HD: Treatment

Answer 44

Stimulants: boost short term memory and activating prefrontal cortex Concerta - Ritalin Nonstimulant: increase availability of norepinephrine - Strattera Therapies - CBT - Behavioral - Executive functioning support

Question 45

Conduct Disorder (CD)

Answer 45

A psychological disorder in childhood and adolescence characterized by disruptive, antisocial behavior 12% males; 7% females Boys - stealing, fighting, vandalism Girls - lying, truancy, running away, substance use, prostitution Average age onset - 11.6 years

Question 46

criteria of Conduct Disorder (CD)

Answer 46

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 from any of the categories below, with at least one criterion present in the past 6 months: --> Aggression to People and Animals --> Destruction of Property --> Serious Violations of Rules 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.

Question 47

Aggression to People and Animals

Answer 47

1. Often bullies, threatens, or intimidates others. 2. Often initiates physical fights. 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun). 4. Has been physically cruel to people. 5. Has been physically cruel to animals. 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery). 7. Has forced someone into sexual activity.

Question 48

Destruction of Property

Answer 48

8. Has deliberately engaged in fire setting with the intention of causing serious damage. 9. Has deliberately destroyed others’ property (other than by fire setting).

Question 49

Deceitfulness or Theft

Answer 49

10. Has broken into someone else’s house, building, or car. 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others). 12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).

Question 50

Serious Violations of Rules

Answer 50

13. Often stays out at night despite parental prohibitions, beginning before age 13 years. 14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period. 15. Is often truant from school, beginning before age 13 years.

Question 51

CD specify if and with

Answer 51

Specify: - Childhood-onset type: Pre age 10 - Adolescent-onset type: 10+ Unspecified onset With limited prosocial emotions: - Lack of remorse or guilt - Callous–lack of empathy - Unconcerned about performance - Shallow or deficient affect mild, mod, sev

Question 52

CD mild, mod, sev

Answer 52

Mild: Few if any conduct problems in excess of those required to make the diagnosis are present, and conduct problems cause relatively minor harm to others (e.g., lying, truancy, staying out after dark without permission, other rule breaking). Moderate: The number of conduct problems and the effect on others are intermediate between those specified in “mild” and those in “severe” (e.g., stealing without confronting a victim, vandalism). Severe: Many conduct problems in excess of those required to make the diagnosis are present, or conduct problems that cause considerable harm to others (e.g., forced sex, physical cruelty, use of a weapon, stealing while confronting a victim, breaking and entering).

Question 53

Oppositional Defiant Disorder (ODD)

Answer 53

A psychological disorder in children and adolescence characterized by excessive oppositionality or tendencies to refuse requests from parents and others Negativistic or oppositional Lose temporary easily, act in a vindictive manner 1-11% of children and adolescents

Question 54

criteria for Oppositional Defiant Disorder (ODD)

Answer 54

A) A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling. --> Angry/Irritable Mood --> Argumentative/Defiant Behavior --> Vindictiveness B) The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning. C) The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder.

Question 55

Specify current severity ODD

Answer 55

Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers). Moderate: Some symptoms are present in at least two settings. Severe: Some symptoms are present in three or more settings.

Question 56

CD and ODD - Theories and Treatment

Answer 56

Temperament Psychodynamic - Unresolved parent-child conflict or parental control - Sign of fixation at the anal stage - when conflicts between the parent and child emerge over toilet training Learning - Inappropriate parental reinforcement strategies (giving in, overly strict) Family factors - Parental distress - Poor or limited parenting skills - Abuse Perceptions of threats of harm Behavioral Treatment for both parents and children, anger management, CBT

Question 57

Anxiety-Related Disorders in Children and Adolescents

Answer 57

Often specific phobias, social phobia, or GAD Cognitive biases: - Negative self talk - Expecting negative outcome - Interpretation of ambiguous situations and threatening Separation anxiety - extreme distress at being separated from parents of primary caregivers Often manifests physically Children lack the words to describe their experiences with these issues- hard to label until age 7 developmentally

Question 58

Anxiety-Related Disorders in Children and Adolescents Theories

Answer 58

Psychodynamic Unconscious conflicts Cognitive Cognitive distortions Learning Fears of rejection or failure

Question 59

Anxiety-Related Disorders in Children and Adolescents Treatment

Answer 59

CBT Play therapy SSRIs

Question 60

Depression in Children and Adolescents

Answer 60

Ranges from 5 to 17 years Similar and identical sx as adult MDD Distinct: - Refusal to attend school - Fear of parental death, clinging - Conduct/academic problems - Physical complaints - Hyperactivity - Aggression/sexual acting out Like anxiety, hard to label until age 7 developmentally

Question 61

Depression in Children and Adolescents Theories

Answer 61

Depending on Age - Stressful life and family events - Exposure to discrimination - Stressful social situations in teens - Negative thinking - Responses to adolescence/puberty

Question 62

Depression in Children and Adolescents Treatment

Answer 62

CBT Play therapy depending on age Psychodynamic SSRIs

Question 63

Suicide in Children and Adolescents

Answer 63

Not just venting → to be taken seriously Suicide is the second-leading cause of death for teens and young adults, ages 10-34 (CDC, 2022). 25.5% of adults ages 18-24 reported having seriously considered suicide in the past month. This is a higher percentage than any other adult age group (CDC, 2020). 18.8% of high school students reported having seriously considered suicide in the past year. This percentage is higher among females (24.1%), and lesbian, gay, or bisexual teens (46.8%) (CDC, 2020). 8.9% of high school students attempted suicide in the past year. This percentage is highest among females (11.0%), black teens (11.8%), and lesbian, gay, or bisexual teens (23.4%) (CDC, 2020). **Think brain development:** C/A have lower levels of inhibition and problem solving strategies developmentally

Question 64

Suicide in Children and Adolescents RISK FACTORS

Answer 64

Gender Geography Ethnicity Depression, hopelessness Previous suicidal behavior Prior sexual abuse Family problems Stressful life events substance abuse Social contagion

Question 65

Elimination Disorders examples

Answer 65

Enuresis and encopresis

Question 66

enuresis

Answer 66

Failure to control urination after one has reached the “normal” age for attaining such control

Question 67

criteria for enuresis

Answer 67

A) Repeated voiding of urine into bed or clothes, whether involuntary or intentional B) The behavior is clinically significant as manifested by either a frequency of at least twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning. C) Chronological age is at least 5 years (or equivalent developmental level). D) The behavior is not attributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure disorder).

Question 68

Specify whether of enuresis

Answer 68

Nocturnal only: Passage of urine only during nighttime sleep. Diurnal only: Passage of urine during waking hours. Nocturnal and diurnal: A combination of the two subtypes above.

Question 69

Theoretical perspectives of Enuresis

Answer 69

Psychodynamic Regression in response to the birth of a sibling or some other stressor or life change Learning theorists Common in children whose parents attempted train them early

Question 70

Treatment of Enuresis

Answer 70

Behavioral methods have been helpful - Alarm Drug treatment

Question 71

Encopresis

Answer 71

Lack of control over bowel movements that is not caused by an organic problem

Question 72

criteria of Encopresis

Answer 72

A) Repeated passage of feces into inappropriate places (e.g., clothing, floor), whether involuntary or intentional. B) At least one such event occurs each month for at least 3 months. C) Chronological age is at least 4 years (or equivalent developmental level). D) The behavior is not attributable to the physiological effects of a substance (e.g., laxatives) or another medical condition except through a mechanism involving constipation.

Question 73

specify whether Encopresis

Answer 73

With constipation and overflow incontinence: There is evidence of constipation on physical examination or by history. Without constipation and overflow incontinence: There is no evidence of constipation on physical examination or by history.