Chapter 15 Flashcards
Autism Spectrum Disorder
- difficulty in social communication/interaction
- repetitive behavior, interests, activities
- encompasses previous diagnoses of autistic disorder, aspergers disorder, childhood disintegrative disorder, pervasive developmental disorder
DSM-5 Criteria for autism
- difficulties in 2 areas: social-communication and restricted, repetitive and/or sensory behaviors/interests
- characteristics from early childhood
- often diagnosed before 30mo
Social Communication difficulties in autism
- rarely using language
- no interest in friends
- no imaginary play
- limited facial expressions
Restricted, repetitive, and sensory behavior/interests
- lining up things in particular way
- repetitive gestures
- very narrow interests
- trouble with change
- sensory sensitivities
Anxiety disorders in childhood and adolescence
- often comorbid
- most common disorder in kids/teens (32%)
- higher rates in girls
- most often specific phobias (almost 20% of kids), social anxiety disorder (5-10%), separation anxiety disorder (7%ish), and PTSD (8% girls, 3% boys)
Phobia types in children (in order)
- Animal (dogs, bugs, snakes)
- Natural environment (dark, storms, heights, water)
- Blood-Injection-Injury (needles, seeing blood/injuries)
- Situational (flying, driving, small spaces)
- Other
Separation anxiety disorder
- excessive anxiety ab separation from major attachment figures/home surroundings
- lack self-confidence, apprehensive in new situations
- slightly more common in girls
- might go away on its own
- more likely to have other anxiety-based disorders (like phobias and OCD)
Causal factors in anxiety disorders (kids/teens)
- anxious children show early sensitivity
- experience of trauma through hospitalization/violence
- parents can foster anxiety in child (overprotective or detached)
Treatment and outcomes in childhood anxiety
- same meds as for adults (esp. benzodiazepines)
- CBT effective at reducing symptoms in young children
- exposure therapy effective for adults, teens, and kids
Childhood depression
- sadness, withdrawal, crying, poor sleep/appetite, suicidal thoughts/attempts
- core feature often irritability (not sadness like in adults)
- about 12% of kids/teens diagnosed
- rates start climbing significantly in adolescence
- higher rates in girls (biggest diff. starts in puberty)
Childhood bipolar disorder
- less often but is still diagnosed in children/teens
- dramatic rise in diagnoses in last decade
- might be both bc world more likely to create bipolar AND bc we are now better at detecting it
Causal factors in childhood depression/bipolar
- genetics play big role
- in utero exposure to alcohol
- exposure to negative parental behaviors/emotional states
Treatment and outcomes in childhood depression/bipolar
- 38% receive mental health treatment
- antidepressants used (but increased risk of suicide)
- CBT reduces symptoms
Video clip on teen suicide
- 44, 000 Americans die by suicide each year (1 every 12 mins)
- over a million attempts per year in US
- increase in annual rates since 1999
- 2nd highest cause of death in young people
- need to give students love and support; they need to know someone cares
- wrote letters to each of 130 students to acknowledge their strengths and encourage them
According to the teacher in the TED talk, ________ is the solution to the teen suicide epidemic
kindness
Oppositional Defiant Disorder (ODD)
- recurrent pattern of negativistic, defiant, disobedient, and hostile behavior towards authority figures for at least 6mo
- angry, argumentative, vindictive
- often develops into conduct disorder (risks: family discord, SES disadvantage, parental antisocial behavior)
Conduct disorder (CD)
- usually diagnosed after ODD
- diagnosed around 12, early diagnosis at 10
- earlier diagnosis more likely to have antisocial PD later
- persistent, repetitive violation of rules and disregard for rights of others
- different from ODD; in ODD kids don’t like being controlled, in CD more aggressive behavior/cruelty
- comorbid w other disorders (esp substance abuse)
- girls more likely to get pregnant
Causal factors in ODD and CD
- self-perpetuating downward spiral
- genetic predisposition: low verbal intelligence, neuropsychological problems, difficult temperament
- strong heritable effect of conduct problems and antisocial behavior
Risks for development of antisocial PD after CD
- younger CD = higher likelihood of psychopathy/antisocial as adult
- stronger link in low SES
- 80% of boys w early-onset CD have multiple problems of social dysfunction as adults
Psychosocial factors in ODD and CD
- being aggressive/socially unskilled leads to rejection
- bad family/neighborhood env. contributes too
Treatments for ODD and CD
- modify family and broader environment
- cohesive family model focusses on ineffective parenting practices that might be contributing
- parent management training
- reinforcing prosocial behaviors, ignoring antisocial/aggressive behaviors
Elimination disorders
- Enuresis, encopresis
Enuresis
- habitual involuntary discharge of urine, usually at night, after age of expected continence (5y)
- 5-10% of 5yo
- 3-5% of 10yo
- 1.1% kids over 15
- might be caused by variety of organic conditions, meds, and/or faulty learning, immaturity, disturbed relationships, SLEs
- decreases with age but treatment still preferable
- can condition to child to wake up when they need to pee; other meds might be used
Encopresis
(just need to know what it is)
- children who haven’t learned proper toileting for bowel mvmts after age 4
- more common in boys
- important to make sure it’s not constipation
- meds or conditioning have moderate success
Neurodevelopmental disorders
- disorders that have to do with brain dysfunction
- wiring/aberrant dev. that doesn’t correct itself
- early in life, so environment doesn’t play a big role
- onset needs to be in childhood
- autism, ADHD, tic disorders
ADHD
- persistent pattern of difficulties sustaining attention and/or impulsiveness and excessive motor activity
- for diagnosis problems need to be numerous, persistent, causing problems at home/work/school
- Lower IQ scores/deficits in neuropsych. testing
- higher rates in boys
- 9% of kids/teens
ADHD beyond adolescence
- about half of kids w ADHD still meet criteria in adulthood
- ab 4% of U.S. adults meet criteria
- higher rates in male, divorced, unemployed
Causal factors in ADHD
- genetic and social-environmental factors
- smaller brain volumes and slower maturing brains
Treatment of ADHD
- Ritalin is a stimulant that quiets child and lowers aggression, increases concentration
- Pemoline and Adderall also stimulants; Straterra is non-stimulant and is less effective
- methylphenidate has an energizing effect in most adults, not calming
- some side effects (stomachache, nausea)
- long-term: lower rates of substance abuse, car accidents, suicide
- teaching organizational/planning skills, techniques for decreasing distractibility and procrastination
Rates of Ritalin users
- significant increase in last 30 years
- most marked increase in 6-12 age group
- questions ab if teachers are just referring any kids with slight behavioral issues
Tic disorders
- tic: persistent, intermittent muscle twitch or spasm, usually limited to localized muscle group
- more common in males
- everyone has some tics (esp when stressed), disorder diagnosed when it interferes w life
- Tourette’s disorder: extreme tic disorder; multiple motor and vocal patterns
Learning disorders
- delays in cognitive dev. in language, speech, math, or motor skills not necessarily due to demonstrable physical/neurological defect
- usually have normal IQ/background
- can experience deep emotional tension under normal learning circumstances
- 30% have comorbid disorder
Dyslexia
- most common learning disorder
- problems w word recognition and reading comprehension
- often letter reversals
- many kids “grow out” of it
Causal factors in learning disorders
- product of subtle CNS impairments
- fMRI studies suggest deficiency of physiological activation in cerebellum in dyslexia
- various forms of learning disorders or vulnerability to develop them can be genetically transmitted
Treatments/outcomes in learning disorders
- most treatments are behavioral interventions
- focus on material needed for academic success
- dyslexia: phonics instruction
- more and more of these kids graduate high school!
Intellectual disabilities
- deficits in general mental abilities (reasoning, problem solving, planning, abstract thinking, judgement, learning)
- aka intellectual development disorder
- defined by intelligence and level of performance
- deficits before 18y (after 18 it’s dementia)
- diagnoses peak at 15
Mild intellectual disability
- IQ 50-70 (>2 SDs below mean)
- considered “educable”
- adult intellectual level comparable to 8-11yo kids
- social adjustment often approximates adolescents’
Moderate intellectual disability
- IQ 35-55
- developmental level similar to 4-7yo kids
- some can learn to read/write but learning is slow and have low conceptualizing levels
- can be somewhat independent in daily self-care and show acceptable behavior if in a sheltered environment
Severe intellectual disability
- IQ 20-40
- impaired speech development, sensory deficits, motor handicaps
- can develop limited levels of personal hygiene but are dependent on others for care
Profound intellectual disability
- IQ below 25
- severely deficient in adaptive behaviors
- unable to master even simple tasks
- often severe deformities, CNS pathology, retarded growth, convulsive seizures, mutism, deafness, etc.
Causal factors in intellectual disability
- genetic-chromosomal factors
- infections/toxins during pregnancy
- trauma (injury), radiation
- malnutrition or other biological factors
Down syndrome
- Langdon Down (1866)
- caused by extra chromosome 21
- best known of clinical conditions associated w moderate/severe intellectual disability
- 5.9 births out of every 10,000 in gen pop
- most affects verbal/language skills
- shorter life expectancy
Phenylketonuria (PKU) - (just need to know name)
- rare metabolic disorder
- missing liver enzyme prevents phenylalanine from being broken down
- 1 in 12,000 births
- both parents must carry recessive gene
- reversible through diet control but can lead to brain damage if left untreated
- can detect through urinalysis
Macrocephaly
- cranial anomaly
- large-headedness
- increase in size/weight of brain results in enlargement of skull
Microcephaly
- cranial anomaly
- small-headedness
- decreased growth of cerebral cortex results in small head circumference
Hydrocephaly
- cranial anomaly
- accumulation of abnormal amount of cerebrospinal fluid, causing damage to the brain
- ventricles fill up and squeeze brain against skull
- treat by implanting shunt into ventricle to drain it into gut
Special considerations in treatment of children and adolescents
- can’t seek assistance
- vulnerabilities place children at risk for developing emotional problems (can’t control environment)
- possibility of using parents as change agents
- might need to treat parents as well
- might need to consider removing child from family but can cause lots of emotional turmoil
- important to intervene before problems become more complex!
Child advocacy programs
- organizations that try to detect children that are experiencing adverse situations and try to mobilize necessary resources to address issues
- resources usually not ideal