Chapter 13

Question 1

Neurodevelopmental Disorders

- includes?

Answer 1

Affecting children and adolescents that involve impaired brain functioning or development; affect childs psych, cog, social, or emotional development
• Includes: Autism spectrum, intellectual disability, specific learning disorder, communication disorders, ADHD

Question 2

Abnormal behavior in children (2)

- cultural study

Answer 2

• Determining abnormal behavior in children depends on what is normal for child for given age/culture; Because children rarely label their own behavior as abnormal definitions of normality depend on how child’s behavior is filtered thru cultural lens
• Study of American and Thai parents presented with vignettes depicting two children; one with prob of overcontrol and one with undercontrol; Thai parents rated both types of problems as less serious than Americans. Thai’s also rated the children as more likely to improve over time even without treatment – imbedded in Thai Buddhist beliefs that tolerate boad ranges of childrens behavior and assume change to be inevitable.

Question 3

Prevalence of Disorders in Children and Adolescents:

1. Adolescents in last year
2. Adolescents currently suffering
3. Children with impairing disorders
4. Most common in children (2)
5. In adolescents
6. Treatment rates
   - risk for being untreated

Answer 3

1. 4 out of 10 Adolescents (40%) have had diagnosis in last year
2. 1 in 4 (23%) presently affected
3. 1 in 10 suffer from mental disorder severe enough to impair development
4. In children 6 to 17, most common disorder is learning disorders (11.5%) and ADHD (8.8%)
5. anxiety disorders
6. Great majority do not get treatment; only about 1/3 of adolescents with mental disorder received treatment
   - Children who have internalized problems like anxiety and depression are at higher risk of being untreated

Question 4

Depression survey

Answer 4

found 7% of boys and 14% of girls ages 12-17 suffered from major depression in preceding 6 months

Question 5

Risk factors for childhood disorders

• risk areas
• parents
• SES
• Gender

Answer 5

• Include genetics, enviro, and family
• Children of depressed parents also stand higher risk of getting disorder
• Ethnic minority children higher risk for problems like ADHD, anxiety, depression (reason unknown)
• Boys at greater risk for many disorders ranging from autism to hyperacticity to elimination disorders; also anxiety and depression
However, in adolescents anxiety and mood disorders become more common in girls

Question 6

Childhood Abuse

• linked to? (6)
• effects
• prevalence
• In US
• Death rate

Answer 6

• Physical and sexual abuse linked to increase risk of: ADHD, anxiety, depression, sub abuse, PTSD, conduct disorder
effects include: low self-esteem, depression, immature behaviors (bed wetting, thumbsuching), suicide thinking, poor school performance, failure to venture beyond the home. These behaviors often lead into adulthood
• 8% of men and 20% of women had suffered sexual abuse before 18
• More than 1.5 million children in US are victims of child abuse or neglect
• Between 1,000 and 2,000 children in US die each year from abuse more than twice the rate of Great Britain, France, Canada, or Japan

Question 7

Autism (1)

• Term
• thinking
• first diagnosis
• gender
• signs
• onset diagnosis

Answer 7

Chronic, life-long condition; placed in ASD
• Term first used in 1906 by Eugen Bleuler to refer to a weird style of thinking among ppl with schizo
• Autistic thinking is the tendency to view oneself as the center of the universe; believe that external events somehow refer to oneself
• 1943, Leo Kanner applied diagnosis of early infantile autism to a group of disturbed children who couldn’t relate to others, creating autistic aloneness
- 5 times as common in boys as girls
•Signs of disorder start at 12 to 18 months – often “good” babies; however as they develop they begin to reject physical affection; speech then falls behind. Signs of social detachment often being during first year (failure to look at ppl’s face)
• Disorder diagnosed reliably by age 2 or 3 but avg autistic child doesn’t get diagnosis until age 6
* Delays are bad; earlier the better

Question 8

Autism Spectrum Disorder

• Clinicians diagnosis
• includes?

Answer 8

developmental disorder characterized by significant deficits in communication and social interaction, as well as development of restricted or fixated interests and repetitive behaviors
• Clinicians need to rate severity of ASD as severe, moderate, or mild
• Asperger’s disorder and childhood disintegrative disorder used in prev DSM to describe distinct spectrum disorders but now are classified as forms of ASD

Question 9

Asperger’s disorder

Answer 9

pattern of behavior involving social awkwardness and repetitive behaviors without significant language or cognitive deficits assoc with more sever forms of ASD. They don’t show deficits in intellectual, verbal and self-care. They may have remarkable verbal skills (read paper by 5) and develop an obsessive interest in narrow topics.

Question 10

Childhood disintegrative disorder

Answer 10

significant loss (disintegration) of prev acquired skills in areas like understanding or using language, social or adaptive functioning, bowel or bladder control, play, motor skills. Rare and appears more in boys.

Question 11

Autism Spectrum Disorder Prevalence

• overall (2)
• US
• cause of rise?
• concern?

Answer 11

• Rates rising over past 20 years
- more than 1 million total- affected by some form
• 2013 estimated 1 in 50 children (2%) in US
- not sure; one cause is couples are postponing having kids more than other generations (Autism linked in children with older fathers)—Still risk is low, only 2% for father’s 40+
- MMR vaccine (measles, mumps, rubella)

Question 12

Autism features -3 core

• general (7)*
• weird language
• peculiar (4)
• IQ

Answer 12

1. Most distinct feature is child’s utter aloneness
2. Others are: deficits in social skills, language, and communication
3. ritualistic stereotyped behavior
4. One of primary features is repetitive, purposelsess, stereotyped movements—interminably twirling, flapping hand, rocking
5. Some children mutilate themselves, bang heads, slap face, bite hands, pull hair
6. Another feature is aversion to environmental changes—preservation of sameness- when fam objects moved even slightly children throw tantrums
7. lack a differentiated self-concept, sense of themselves as distinct individuals
   -May be mute; if some language skills present may use peculiarly as in:
8. Echolalia—parroting back what the child has heard in high pitched monotone
9. Pronoun reversals (using you, or he instead of I)
10. Making up own language
11. Raising voice at end of sentences
    • Nonverbal communication may also be impaired (avoid eye contact; absence of facial expressions)
    • Some have norm IQ’s but many don’t

Question 13

Theoretical Perspective of Autism

3. bio
4. bio-2
5. Overall, scientists believe?-2
6. Bio

Answer 13

1. Old belief that autistic child’s aloofness was reaction to parents who were cold and detached - don’t know what causes it
2. O. Ivar Lovaas and colleagues offered a cognitive learning perspective on autism—suggest that they have perceptual probs that limit them to processing only one stimulus at a time; results in slow learning by means of classical conditioning. Normal children become attached to caregiver through assocs with primary reinforcers like food and hugging. Autistic children attend either to food or cuddling and don’t assoc with parent
3. Autistic children often have trouble integrating info from various senses; sometimes seem insensitive other times very. Perceptual and cog deficits seem to diminish their capacity to make use of info—to comprehend and apply social rules
4. Prenatal influence on abnormal brain circuit and structural damage involving loss of brain tissue. Evidence links greater risk of ASDs to prenatal risk factors like flu or prolonged fevers in mother maybe affecting fetus’s brain
5. brain of child with autism develops abnormally due to combo of genes and enviro (toxins/virus)-discovered mutations on three genes linked to autism
6. parts of brain in charge of language and social behavior grow slower

Question 14

Treatment for autism

2. a type
3. study
4. infant treatment
5. drugs
6. success

Answer 14

• Early intensive behavioral programs that apply learning principles in child’s environment can improve learning and language skills–The earler the treatment is started (before age 5) and the more intense the better results
• Applied behavior analysis (ABA) learning based model- no other has had comparable results; uses operant conditioning where parents and therapists engage in the painstaking work, systematically using rewards and punishments to increase child’s ability to attend to others, play with others, develop academic skills, and reduce or eliminate self-mutilation
• O. Ivar Lovaas study: showed impressive gains in autistic children who go more than 40 hours of treatment for each week for two years
-benefit from early training focusing on imitation skills
- antipsych drugs to control disruptive behavior but work better when combined with learning treatment
• Small subset who appear to overcome disorder

Question 15

Intellectual Disability

• Prevalence
• onset/course
• diagnostic criteria
• diagnostic types
• most common type

Answer 15

(formerly called MR) generalized delay or impairment in development of intellectual and adaptive abilities; lack basic conceptual, social, and practical skills of daily living. Children tend to have deficits in reasoning and problem solving, abstract thinking, judgment, school performance
- 1%
- before 18; lifelong course however many improve over time
- basis of low IQ score and impaired adaptive functioning resulting in impairment in meeting expected standards of independent functioning and social responsibility. Impairments involve difficulty preforming common tasks of daily life in three domains:
1. Conceptual (skills relating to use of language, reading, writing, math)
2. Social (skills relating to awareness of other peoples experiences, communicate with others, form friendships)
3. Practical (ability to meet personal care need, fulfill job responsibilities, manage money)
- based on severity; Level of severity is based on child’s adaptive functioning
• Most with ID (85%) fall into mild range—able to meet basic academics like reading simple passages; as adults they are capable of independent functioning

Question 16

Causes of ID (2)

1. (4)
2. (1)

Answer 16

• Include bio and psychosocial factors
• Biological causes: chromosomal and genetic disorders, infectious diseases, and maternal alcohol use.
• Psychosocial causes: exposure to impoverished home environment with lack of intellectually stimulating activities

Question 17

Chromosomal Abnormalities

Answer 17

Down syndrome, Klinefelter’s syndrome, Turner’s syndrome

Question 18

Down syndrome

• prevalence
• cause
• increased risk
• features
• other problems
• disabilities

Answer 18

• Most frequent ID; condition cause by extra chromo on 21st pair (resulting in 47 chromos rather than 46) and characterized by intellectual developmental disorder and physical abnormalities
• Occurs in 1 in 800 births
• Happens when 21st pair in either egg or sperm fails to divide normally resulting in extra chromo
• Expectant couples in mid 30’s; Down syndrome can be traced to mother’s egg in about 90% of cases
- Round broad face, flat nose, small downward sloping folds of skin at inside corners of eyes—gives impression of slanted eyes. A protruding tongue, small arms, curved fifth finger
- many suffer from physical probs like malformations of heart and respiratory difficulties; almost all have ID; LE is 49
- Tend to be uncoordinated, lack muscle tone, suffer memory deficits especially verbal info presented; Despite disabilities most can learn to read, write, and perform simple math

Question 19

Klinefelter’s syndrome

• cause
• prevalence
• features

Answer 19

• Abnormalities on sex chromos which can result in an ID
Occurs only in males – presence of extra X chromo resulting in an XXY pattern
• Only 2 per 1,000 male births
• These men fail to get secondary sex charactersitics resulting in breasts, small testes, low sperm, and infertility.
• Often don’t know they have it until tested for fertililiy

Question 20

Turner’s syndrome

• cause
• features

Answer 20

• Occurs only in females
• Presence of single X instead of normal two
• Develop normal external genitals but ovaries are poorly developed producing reduced amounts of estrogen
• As woman they are infertile, have endocrine and CV probs
• Show mild ID in math and science skills especially

Question 21

Genetic abnormalities

Answer 21

Fragile X, Phenylketonuria (PKU)

Question 22

Fragile X syndrome

• prevalence
• cause
• features

Answer 22

Most common genetic cause; affects 1 of 1,000 to 1,500 males and 1 of 2,000 to 2,500 females
Second common form of ID after down syndrome
• Caused by mutation on single gene in area of X chromo that appears fragile
• range from mild learning disorders to ID so profound that they can hardly speak or function
• Females normally have two X chromos; males one. Females two X’s provide protection against disorder if defective gene turns up –which only leads to mild disability
• Many males and females carry the fragile X mutation without showing any signs

Question 23

Phenylketonuria (PKU)

• prevalence
• cause
• treatment

Answer 23

• Occurs in 1 in 10,000 to 15,000 births
• Caused by recessive gene that prevents child from metabolizing the amino acid phenylalanine which is found in many foods. Results in it accumulating along with phenyplpyruvic acid in body causing damage to CNS leading to intellectual disabilities
• PKU can be found in newborns with testing urine and blood
• No cure but can be placed on special diet to suffer less damage; receive protein supplements to give nutrition

Question 24

Prenatal tests - 2

Answer 24

• Today there are many prenatal tests that can detect chromo and genetic disorders
• Amniocentesis is conducted 14 to 15 weeks following conception where small sample of amniotic fluid is drawn

Question 25

Prenatal factors in ID -5

Answer 25

1. Some cases of ID caused by maternal infections like: Rubella, syphilis, cytomegalovirus, genital herpes but Immunizations in women before pregnancy have reduced risk of transmission
2. Fetal alcohol syndrome is one of the most prominent causes of ID
3. Birth complications (oxygen depreivation) place children at risk of ID; Prematurity also increases
4. Brain infections (encephalitis, meningitis) can result in ID
5. Toxins like paint chips can cause it also

Question 26

Cultural/familial causes of ID - 6

Answer 26

• Most cases of ID fall in the mild range of severity and have no apparent biological cause or distinguishing feature
• These cases are cultural-familial roots like impoverished homes or social enviro lacking stimulating activities
• Lack of toys, books, economic burden of parent being away at work, all lead to underdevelopment of language skills and motivation to learn
• Vicious cycle of poverty and impoverished intellectual development repeated from generation to generation (ID parent=ID child)
• Children with family form of ID may respond dramatically when given chance to learn
• Head start social program has helped many function in normal range

Question 27

Interventions for ID

• Prognosis (2)
• controversy
• revolutionary
• population of institutions
• Emotions in ID

Answer 27

• With training, children with mild forms of ID may reach six grade level of competence. Other extreme cases placed in residential care – often based on need to control aggressive behavior not bc of severity of ID
• Disagreement over whether ID children should be mainstreamed into reg classes—some improve others don’t
• Trend towards deinstitutionalization of ppl with more severe ID motivated by public outrage over appalling conditions that formaly existed in many institutions Developmentally disabled assistance and bill of rights act, passed in 1975 gave ppl with ID the right to receive approp treatment in least restrictive treatment setting
• Nationwide the pop of insituions for ppl with ID shrank by 2/3’s in years following bill
• Those with ID stand high risk of developing other psych disorders like depression and anxiety. Emotional life of ppl with ID received lil attention—many assume that ppl with ID are somehow immune to these probs or lack verbal skills for therapy. However evidence shows that they can benfit from psych treatment

Question 28

Treatments for ID (2)

Answer 28

• Psych counseling with behavioral techs help them acquire skills in personal hygiene, work , social relationships
• Structural behavioral approaches used to teach those with more severe ID to master basic hygiene like tooth brushing, dressing, hair combing

Question 29

Learning Disorders

- types

Answer 29

deficiency in a specific learning ability in context of normal intelligence and exposure to learning opportunities; Typically chronic disorders that affect into adulthood
Children with this often viewed as failures; often have other probs like low self-esteem and high risk of developing ADHD
- Specific learning disorder
also problems with reading, writing, math, and executive functions

Question 30

Specific learning disorder

• prevalence
• onset
• diagnosis
• deficits

Answer 30

− DSM single diagnosis to encompass various LD’s involving deficits in skills of reading, writing, arithmetic and executive functions.
- 5 to 15% school aged children
− Deficits emerge during grade school years but may not be recognized until academic demands exceed the individuals abilities
− Diagnosis also requires that learning deficits cannot be better explained by a generalized delay in intellectual development (ID) of by underlying neuro med conditions.
− Commonly combo of specific deficits in academic, social, and occupational functioning

Question 31

Problems with reading

• prevelance
• onset/gender
• comorbidty
• culture diffs

Answer 31

− Dyslexia- Most common type of LD accounting for 80% of cases; impaired reading ability with at least avg intelligence
− DSM does not use term dyslexia although still used to describe probs with reading
− Struggle to understand or recognized basic words or comprehend what they read; read slow, distort, emit words. Trouble decoding letters and translating to sounds; may misperceive letters as upside down or reversed
− Affects 4% of school aged children; more common in boys
− Boys more likely to show disruptive behavior and go for evaluation
− Usually apparent by age of 7 (2nd grade)
− Prone to probs with depression and ADHD
− Rates are higher in English speaking and French speaking countries where language contains large number of ways of spelling words containing the same sounds (toe and tow)
− Low in Italy

Question 32

Problems with writing

- onset

Answer 32

− Errors in spelling, grammar, or punctuations. Probs with legibility or fluent handwriting or difficulty composing sentences
− Severe ones become apparent by age 7
− Milder cases not until 10 (5th grade)

Question 33

Problems with math and reasoning skills

- onset

Answer 33

− Apparent by age 6 (1st grade) but generally not recognized until 2nd or 3rd grade.
− Include probs with addition, subtraction, learning multiplaction tables

Question 34

Problems with executive functions

Answer 34

− Sets of higher mental abilities involved in planning, organizing, coordinating tasks
− Trouble organizing school related tasks and freq fall behind in school work or fail to plan assingments ahead

Question 35

Dyslexia perspective

• Bio
• Bio
• Influence?
• Influence- 2
• 2.

Answer 35

• Much of research focuses on dyslexia with evidence of brain abnormalities in visual and auditory info processing
• Difficutly connecting sounds that correspond to letters and distinguishing speech sounds
• Evidence points to genetic influence
Dyslexia may take 2 general forms: on genetically influenced and one enviro
•Genetic form appears to involve probs in neural circuits in brain that readers use to process speech sounds; these children compensated for this defect by reading slowly
•Enviro form appears to be rely on memory more than decoding strategies to understand words; more prevalent in disadvantaged children and assoc with more persistent reading disability

Question 36

Learning disorder perspective and treatment

Answer 36

• Linking learning disorders to defects in brain circuits for prosccessing sensory (visual and audio) info may point toward treatments programs that help children adjust to their sensory capabilities
• Therapist’s need to design techs that tailor to particular type and edu background

Question 37

Communication Disorders

- types

Answer 37

persistent difficulties in understanding or using language, or speaking clearly
include: language disorder, speech sound disorder, childhood onset fluency disorder, and social pragmatic comm disorder

Question 38

Language disorder

Answer 38

impairments in ability to produce or understand spoken language
include: slow vocab development, errors in tenses, difficulties recalling words, probs producing sentences of length/complexity
• Affected children may also have a speech sound articulation disorder compounding speech problems
• May have hard time understanding words; sometimes it’s a certain word type (quantity), spatial terms (near) or sentence types

Question 39

Speech sound disorder

- treatment success

Answer 39

(formerly called phonological disorder) difficulty in articulating speech in absence of defective oral speech mechanism or neuro impairment
• Child may omit, sub, or mispronounce certain sounds
• May sound as if they are uttering baby talk
• Speech therapy often helpful and mild cases often resolve by age of 8

Question 40

Childhood onset fluency disorder

• prevalence
• onset/gender
• prognosis
• causes
• recent discovery
• other components

Answer 40

persistent stuttering; difficulty speaking fluently with appropriate timing of speech sounds
- 1%
•Usually begins between 2 and 7 years old
•Occurs 3x as many males as females
•Most who stutter 80% overcome prob without any treatment before 16
•Characterized by one or more of following: repetition of sounds, prolongations of certain sounds, interjections of inappropriate sounds, broken words, blocking of speech, circumlocutions (subbing alternative words to avoid problematic ones), excess of physical tension, repetitions of monosyllabic words.
•Causes unknown but maybe genetics
Genetics involved with controlling speech producing muscles
• Recent disorvery of mutation on gene linked to stuttering
•Emotional component –Children tend to be more emotionally reactive when faced with stress they become more upset
Also tend to be troubled with social anxiety about what others think of them

Question 41

Social pragmatic communication disorder

- diagnosis

Answer 41

difficutlites communicating with others in social contexts
•New in DSM
•Diagnosis only applys to children who have continiuing tourble communicating verbally and nonverbally with others in natural contexts (school)

Question 42

Treatment of communication disorders

Answer 42

• Often with specialized speech and language therapy or with fluency training which involves learning to speak more slowly and to regulate ones breathing
• Stuttering may include psych counseling for anxiey

Question 43

Behavior Problems

Answer 43

• ADHD, ODD, CD
Useful to link all 3 together because they all involve problem behaviors that can seriously interfere with functioning in school or at home.
•The disorders are socially disruptive and are more upsetting to others than to those children who are diagnosed
•Rate of comorbidity very high

Question 44

ADHD

• prevalence (2)
• meds
• Gender
• onset
• comorbidity

Answer 44

excessive motor activity and inability to focus attention; display impulsivity inattention, and hyperactivity
• Affects between 7-9% of children and adolescents in US
• More than 6 million children 4 thru 17 in US diagnosed
• 2/3rds of those children are take medication
• Diagnosed 2-9x more often in boys
• Black and Hispanic children are less likely to receive the diagnoses than Whites
• Usually first diagnosed in elementary school however the inattentive or hyperactive and impulsive features may arise at any time before the age of 12
• Freq occurs with LD, Conduct, anxiety, depression and communication disorders

Question 45

ADHD in adults

• prevalence
• treatment

Answer 45

• Usaully takes form of inattention, probs with working mem, distractibility rather than hyperactivity in adults
- 4% of adults
• Evidence shows benefits for adults treated with form of cognitive training focusing on organizational, planning, and time management skills

Question 46

Theoretical perspectives of ADHD

1. Bio
2. Enviro
3. Enviro
4. Both
5. Bio

Answer 46

1. Role of genetics—higher concordance rates among MZ twins than DZ
2. Also enviro factors: maternal smoking, maternal emotional stress, family conflict, poor disciplining
3. Recent evidence showed lead exposure increased ADHD symptoms in children
4. Recently learned that genetic variations increase risk BUT only with inconcsistent parenting
5. ADHD may be attributed to executive functions in brain involving process of attention and restraint of impulsive behaviors need to organize and follow thru with goals –supported by brain imaging showing delayed maturation in parts of brain especially in PFC

Question 47

Treatment for ADHD
1. Drugs
2. probe with them (3)
3. short-term side effects
4. long-term effects
5. New drug
6. psych interventions
(success)

Answer 47

1. drugs used to calm the children down are stimulants ( Ritalin, Concerta); stimulate the PFC which regs the intentional processes and impulsive behaviors
   Drugs even used for 3 to 5 year olds
2. Common prob with medication is high rate of relapse after stopping meds; also range of effectiveness; not sure if meds acutely improve academics
3. Short-term side effects: loss of appetitie, insomnia, usually go away in few weeks.
4. Can lead to slow down of growth; tho children eventually catch up
5. Strattera was the first nonstimulant drug used for ADHD. It is a SNRI (selective norepinephrine). Not sure how it works—norepine may enhance ability to regulate attention and impulses Strattera isn’t as effective as Ritalin
6. Psych interventions still needed to help develop adaptive behaviors
   Behavior modification programs to train parents and teachers to use contingent reinforcement for good behaviors combined with cognitive modification
   CBT helps them learn to stop and think before acting out aggressive impulses
   •Evidence backs up effectiveness although not as strong as drugs

Question 48

Conduct disorder

• Prevalence/ gender
• gender diffs
• comorbidity
• onset/course

Answer 48

disruptive antisocial behavior purposefully engage in antisocial behavior that violates social norms; intentionally aggressive; bullying and threatening; no remorse for others; lie and destroy property
- Common and affects 12% males and 7%females (9.5% overall)
- in boys it is exhibited as stealing, fighting, vandalizing where girls its is lying, truancy, running away, sub abuse, prostitution
- ADHD, major depression, and sub abuse disorders
• Average onset of CD is 11.6 years (although can happen earlier or later)
Typically chronic and persistent

Question 49

Oppositional Defiant Disorder

• onset
• course of development
• prevalence
• gender

Answer 49

excessive oppositionality or tendencies to refuse requests from parents or others; Overly negativistic or oppositional; deliberately annoy others; easily angered or lost temper; feel resentful toward others or act in spiteful ways involves more nondeliquent forms of conduct disturbance.
• Typically develops earlier than CD and may lead to CD later (only minority do)
• Begins before 8 and develops gradually typically starting at home
• One of the most common diagnoses and affects 1-11% of children
• More in boys than girls before 12 but unsure in adolescents

Question 50

Theoretical perspective of CD and ODD
- 2
Treatment approaches: 5

Answer 50

•Both often show biased ways of processing social info (wrongly assuming that others did them wrong)and Quick to blame others
• Cognitive deficits may include inability to generate alternative nonviolent responses to social conflicts
1. Behaviorally based parent-training programs often used to help parents reduce kid’s aggressive disruptive and oppositional behavior and increase adaptive behaviors.
2. Treatment goals: helping parents use more consistent rules and effective discipline techs, increase positive reinforcement, increase positive interactions with child
3. Anger control training also used
4. CD children Sometimes placed in residential programs that establish strict rules with clear rewards and mild punishments
5. CBT also used to teach aggressive children to re-conceptualize social provocations as problems to be solved rather than as challenges to use violence; use calming self-talk to inhibit impulsive behavior

Question 51

ODD perspectives

• possible causes (2)
• psychodynamic
• Learning theory
• bio

Answer 51

•Casual factors unclear
Maybe expression of underlying termperamnet described as difficult child type; Some believe its an unresolved parent child conflict or overly strict parental control
• Psychodynamic theorists see as sign of fixtation at anal stage when conflicts happen over toilet training –later expressed as rebellion
• Learning theorists see oppositional behaviors arising form parental use of bad reinforcements. Parents may reinforce opposition by giving in
• Genes may contribute

Question 52

CD perspective

2

Answer 52

1. Family factors implicated and often develops in context of negative parenting such as not postiviely reinforcing or praising child and use of harsh discipline. Family interactions often negative. Family members may reciprocate demanding and noncompliant behavior of children by yelling or physically threatening.
   Parent modeling of antisocial behaviors
   CD often develops in context of parental distress such as marital conflict
2. Genetic contribution interacting with enviro (physical abuse and harsh parenting increases risk only with certain gene profile)

Question 53

Anxiety disorders

• types
• prevalence
• Anxiety in children

Answer 53

• Children may suffer from phobic, GAD, OCD and PTSD
• Anxiety disorders are most common type of psych disorders affecting adolescents
• Anxiety probs often go unrecognized and undertreated bc hard to distinguish normal developmentally appropriate fears; also bc many report physical symptoms

Question 54

Separation anxiety disorder

• prevalence (2)
• gender
• comorbidity
• school (2)
• cause

Answer 54

extreme fear of separation from parents or other caretaker
• Affects 4 to 5% of children and is most common anxiety disorder affecting children under age of 12
• Occurs more in girls and often assoc with school refusal
• Freq occurs with social anxiety
• Not a school phobia bc it can exist in preschool ages
• School refusal in adolscesnts often linked to academic or social concerns so not SAD
• Mary Ainsworth proposed development of attachment behaviors and found that separation anxiety normally begins in first year
Sense of security provided by bond to parents encourages child to explore
Strong attachment to mother help buffer effects of later stress. Insecure attacments lead to disorders in face of negative life events

Question 55

Perspectives on childhood anxiety*

1. psychodynamic
2. Cognitive
3. learning
4. bio

Answer 55

• almost same as ones in adults
  1. propose that childhood anxiety symbolize unconscious conflicts
  2. say its cognitive biases—children tend to show cognitive distortions found in adults with anxiety; engage in neg self-talk; negative expectations heighten anxiety
  3. suggests anxiety comes from fear of rejection or failure that generalize to situations
  4. Genetic factors also contribute including specific phobias

Question 56

Treatments of anxiety disorders

4. Study with effects

Answer 56

1. CBT techs for adults like grad expo to phobic stimuli and relaxation training can benefit
2. Cognitive techs can help them identify anxiety generating thoughts and replace with calming alternative ones
   - CBT has shown good results for children and teens
3. Antideps: SSRIs work well
4. Study of 448 children with SAD, GAD or social phobia received CBT, meds, or both –greatest was both

Question 57

Childhood depression

• prevalence (children/teens)
• gender
• symptoms
• other disorders
• main difference in feature
• best predictor in teens
• lasts how long?

Answer 57

• Major depression is most common mood disorder affecting about 5% of children 5-12.9 years old; Affects 20% of adolescents from 13-17
• Even can occur among preschoolers, although rare
• Girls more likely to have first MD episode during childhood or adolescence but no gender diff in likelihood of having recurrent episode; teen girls tend to show more depress symptoms than boys
• Same symptoms as adults although usually don’t have increased appetitie and weight gain
• Can be masked by conduct, academic probems, physical complaints, and hyperactivity
• May not report feeling sad; only bored or irritable –part of problem is cognitive development and being unable to recognizing internal feelings until about 7
• Becoming isolated form friends in late childhood predicts development of depression in early adolescenece
• Major depressive episodes in children can last upward of year or longer yet childhood depression rearely occurs alone—anxiety, CD or ODD often occur and eating disorders

Question 58

Perspectives of childhood depression

3. cultural similarities

Answer 58

•Frequently related to family problems

• Negative thinking styles being to enter the picture as children mature and cognitive abilities develop; distorted patterns include: Expecting the worst, catastrophizing consequences of neg events, blaming themselves for diappointments, minimizing accomplishments
• Distorted thinking also in Chines children in Hong Kong school who minimized accomplishments and blew failures out of porpertion

Question 59

Depression treatment (4)

Answer 59

1. Evidence supports CBT—75% of depressed youths no longer showed signs
   CBT typically involves social skills training, problem solving training, increasing rewarding activities, and countering depressive thoughts.
2. Family therapy may also help
3. Lithium can be used to treat bipolar but questions about effectiveness with children
4. SSRI (Prozac) show benefits in treating depression

Question 60

Suicide

• overall prevalence in children/teens
• college student rate
• age group rate (2)

Answer 60

• Is rare in children and early adolescence but becomes common in late adolescence
• Among college students it’s the 2nd cuase of death
• In 15-24 year old age group, suicide is the 3rd most common cause of death; Approx 1 per 10,000 (.01%) in this age range commits suicide

Question 61

Factors associated with increased suicide risk (10)

Answer 61

1. Gender- Girls 3x more likely to attempt however boys more likely to succeed
2. Geography- teens in less pop areas more likely to commit; teens in rural western regions of US have highest suicide rate
3. Ethnicity- rates for blacks, Asians, Hispaniacs are about 30%to 60% lower that white—yet highest rates in US among Native Americans
4. Depression and hoplessness
5. Previous suicidal behavior- one quarter of teens who attempt are repeaters; more than 80% who took life have talked about it
6. Prior sexual abuse- Australian sample childhood history of abuse gave rates more than 10x higher than national average; One third who have been abused attempted suicide
7. Family problems- Instability and conflict, loss of parent, poor communication
8. Stressful life events- Many suicides in you ppl preceded by traumatic stressful event such as breaking up or taking test
9. Substance abuse- in teen or family
10. Social contagion- romanticize suicide as heroic

Question 62

Enuresis

• to diagnose
• prevalence/gender
• types

Answer 62

failure to control urination after one has reached normal age for attaining control. • Bed-wetting most common and usually occurs during deepest sleep and may reflect immature nervous system

• Child must be at least 5 years of age or at an equivalent level of development and meet following criteria: Repeatedly wet bed or clothes (intentionally or involuntarily), wetting occurs at least twice a week for three months Or cause significant distress, no medical organic cause
• Affects 7 million children age 6 and over in US; more common in boys; 5-10% of children meet diagnostic criteria at age 5
  1. Primary enuresis is the most prevalent form of the disorder; characterizes children with persistent bed-wetting who have never established urinary control thru night. Due to maturational delays with genetic underpinnings
  2. Secondary enuresis is not genetically influences and characterizes those who occasionally wet bed after developing urinary control

Question 63

Theoretical perspectives of enuresis

1. psychodynamic
2. learning
3. primary

Answer 63

1. represents the expression of hostility toward parents because of harsh toilet training. May represent response to birth of sibling or some others stressor in life.
2. point out that it occurs most commonly in children whose parents trained too early; early failures may have connected anxiety with efforts to control the bladder. Conditioned anxiety then induces rather than curbs urination
3. Genes implicated regulate development of motor control over eliminatory reflexes by cerebral cortex

Question 64

Treatment of enuresis (2)

- most succsful

Answer 64

•Behavioral methods shown to be helpful including waking up child when bladder is full (urine alarm – tech developed by O. Hobart Mowrer in 1930s)
Urine alarm classical conditioning: Tension in bladder paired with stimulus (alarm) that wake them up when they wet bed. Bladder tension (CS) elicits waking response (CR) that is elicited by the alarm (UCS)
Urine alarm has highest cure rates and lowest relapse rates
•Luvox—an SSRI also used

Question 65

Encopresis

• prevalence
• predisposing factors

Answer 65

lack of control over bowl movements that is not caused by organic problem in a child who is at least 4; voluntary or involuntary; When soiling is involuntary often involves constipation, impaction, or retention that results in subsequent overflow
• 1% of 5 year old have this; Most common in boys
- inconsistent toilet training, psychosocial stressors like new sibling.