Chapter 8: Early Onset Disorders

Question 1

What are all of the Early Onset Emotional Disorders?

Answer 1

1. Reactive attachment disorder
2. Phobia
3. Childhood Depression
4. Separation Anxiety Disorder

Question 2

What are the two kinds of Reactive Attachment Disorder and how are they different?

Answer 2

1. Inhibited type
   a. Failure to initiate or respond to interpersonal situations
   b. Resists physical contact or comforting
   c. Observes others’ behavior
2. Uninhibited type
   a. Indiscriminate in social interactions and responses
   b. Lots of physical interaction and need for comforting.

Question 3

What is Separation Anxiety Disorder?

Answer 3

1. Cling to loved ones, nightmares about separation, physical symptoms of anxiety, headaches, stomach aches, nausea, particularly on days where they become separated.
2. Two continuous weeks or more constitutes Separation anxiety disorder

Question 4

Who is most vulnerable to separation anxiety?

Answer 4

• Children of parents with social phobia, depression or anxiety disorder.
• Girls, who are four times more likely than boys.

Question 5

Treatment for separation anxiety?

Answer 5

• CBT

- Antidepressants

Question 6

Stats for Childhood Depression

Answer 6

• 21.3% for women and 12.7% for men
• 4-3% in children and .4-8% in adolescence
• Adolescent female depression is approaching the same rate as for adult women

Question 7

Risk factors of Childhood Depression

Answer 7

• Same as for adults
• Family history of depression
• Stressful life events
• Low self-esteem
• Pessimistic attitude.
• Parental conflict

Question 8

Treatments for Depression

Answer 8

• CT
• BT
• CBT
• SSRI

Question 9

Define Autism Disorder and Identify its Symptoms

Answer 9

• Failure to produce and recognize emotional responses or reactions.
• Rigid, ritualistic behavior
• Inability to make abstract thoughts, such as make believe
• Restricted and intense interest in one subject
• Stereotyped movements

Question 10

Psychogenic Theories of Autism’s Etiology

Answer 10

• Raised in emotional refrigeration
• Parents with logical, non-feeling, cold and calculating demeanors
• Parental distancing > shying away from affection
• Meticulous behavior > obsessions and ritualistic behavior
• However, most of these theories prove to be false

Question 11

Biological explanations of autism

Answer 11

• Larger than normal brain volume
• Smaller cerebellum
• Epilepsy 30% higher in children with autism
• More serotonin
• More instances of Fragile X Syndrome, phenylketonuria, rubella (Also within womb), encephalitis

Question 12

Treatment for autism

Answer 12

Medication

• Methylphenidate used for increasing attention capacity
• SSRIs for stereotypes, preservation and mood swings

Behavioral therapy
-Cognitive, behavioral, motor and perceptual handicaps are addressed

Educational rehabilitation
-Language development

Question 13

Rett’s Disorder Symptoms

Answer 13

1. Deceleration of head growth between ages 5 and 48 months
2. Loss of previously acquired purposeful hand skills between 5 and 30 months with the subsequent development of stereotyped hand movements
3. Loss of social engagement early in the course
4. Appearance of poorly coordinated gait or trunk movements
5. Severely impaired expressive and receptive language development with severe psychomotor retardation
6. Stereotyped and repetitive hand or finger motions or whole body movements
7. Most with Rett’s suffer mental retardation
8. Persistent and progressive

Question 14

Childhood Degenerative Disorder

Answer 14

Two years of normal development but then loss of the following:

1. Expressive or receptive language
2. Social skills or adaptive behavior
3. Bowel or bladder control
4. Play
5. Motor skills

Question 15

Treatment for Childhood Degenerative Disorder

Answer 15

1. Intensive behavioral therapy
2. Educational programs
3. In some cases, medication

Question 16

Asperger’s Syndrome

Answer 16

i. Latest onset; not detected until preschool
ii. .1-.26% of population
iii. Limited interests
iv. Impaired social interaction
v. Body posture and gestures are almost mechanical
vi. Very similar to autism though less severe
vii. Low range of facial expressions
viii. Savantism

Question 17

Mild retardation

Answer 17

i. Not noticed until third grade
ii. Regular communication and social skills
iii. Academic difficulties by third grade
iv. Need more guidance than most children but can adequately function in unskilled or semiskilled jobs

Question 18

Moderate retardation

Answer 18

I. Learn to talk and communicate during preschool period

ii. Lack of social conventions
iii. Unlikely to go beyond second grade level in academic progress
iv. Clumsy and poor motor skills
v. Can learn to travel alone in familiar places and can often contribute to their own support by working at semiskilled or unskilled tasks in protected settings

Question 19

Severe retardation

Answer 19

i. Before age of five
ii. Poor motor development
iii. Little to no communication or speech
iv. Special school: learn to talk and can be trained in elementary hygiene.
v. Unable to profit from vocational training
vi. May be able to perform simple, unskilled job tasks under supervision

Question 20

Profound retardation

Answer 20

I. Severely handicapped in adaptive behavior

ii. Physical deformity
iii. Central nervous system difficulties
iv. Retarded growth
v. Health and resistance to disease are poor.
vi. Short life expectancy
vii. Require custodial care

Question 21

Genetic Causes of Mental Retardation

Answer 21

• Fragile X Syndrome
• Down Syndrome
• Phenylkotenuria

Question 22

Environmental Causes of Retardation

Answer 22

1. Rubella
2. Fetal Alcohol Syndrome
3. Lower income women are more likely to give birth to premature infants with low birth weight, increasing the chances of mental retardation
4. Sometimes faulty delivers where oxygen is cut off to the infant can have effect on whether the infant becomes retarded.
5. Lower income communities
   a. Toxic lead exposure
   b. Malnourishment
6. Physical blows to the head or violent shaking
7. Cultural-familial retardation
   a. Insufficient intellectual stimulation
   b. Lower income families with little resources or educational background

Question 23

Treatment of Retardation

Answer 23

1. Intellectual intervention at an early age
2. Programs for training them for independent living and social interaction
3. Special education programs
   a. Emphasis on language and self-care
4. Some say they should be mainstreamed with other children
   a. Eventually they will be living with their normal peers, so why not be learning with them?
5. Some say they should be in separate classes
6. Mix of both separate and mainstreamed classes is optimal.

Question 24

Physical Symptoms of an Eating Disorder

Answer 24

• Begin in adolescence and rarely continue into adulthood
• Low body heat and blood pressure
• Life threatening cardiac arrhythmias
• Retarded bone growth or osteoporosis
• Anemia are common
• Low levels of serum potassium caused by starvation can lead to irregularities in the heart that may cause death
• Infrequent period.
• Loss of electrolytes which regulate heart, can sometimes lead to heart failure.

Question 25

Stuttering Disorders Treatments

Answer 25

- Speech Therapy - Delayed Audio Feedback - Shadowing - Therapist reads, child repeats - Syllable-timed speech - Speak with metronome

Question 26

Tic Disorder: Tourettes (a.k.a. Coprolalia) Causes

Answer 26

- Subcortical areas of the brain, particularly basal ganglia, where there is a high concentration of dopamine receptors - Thalamus also has been implicated - Have control over the limbs and face

Question 27

Treatment of Tourette's

Answer 27

-Anti-psychotic medication

Question 28

Conduct Disorder: Environmental Causes

Answer 28

- Increased availability in guns. - Single parent, unstable homes where discipline is inconsistent. - Coercive anger and behaviors and lack of enforcement of pro-social behavior. - Exposure to media violence - Difficulty forming peer relationships - Family difficulties are augmented by poverty (e.g, inner city youth)

Question 29

Biological Causes of Conduct Disorder

Answer 29

- Cigarette smoking in the womb - Lack of serotonin receptors has link to aggressive/violent behavior, also leading to depression - Frontal lobe damage leading to impulsive behavior - Low on “executive” function, such as the ability to plan ahead and refrain from impulsive responses - -Social ineptitude

Question 30

How does a low resting heart rate lead to conduct disorder?

Answer 30

- Low-level arousal - Requiring more stimulus to gain a response - Could mean they are also less capable of social learning - Less responsive to praise and punishment - They experience less discomfort when they violate social norms.

Question 31

Treatments of Conduct Disorder

Answer 31

- Cognitive problem-solving skills - Parent Management Training - Treatment Homes - Family Therapy - Multisystemic Therapy

Question 32

Oppositional Defiant Disorder

Answer 32

- 2% prevalence in children - More likely to turn into conduct disorder - Children with it do not engage in repeated physical aggression, property destruction, theft or deceit.

Question 33

Causes of ODD

Answer 33

- Unstable, unpredictable homes where parents use harsh, inconsistent punishments and are less involved in child’s activities. - Reduction in indicators of serotonin activity. - Thus, treatments to children with OCD are same for children with CD. - ODD more genetic than CD.

Question 34

Hyperactivity/Compulsory Behavior in ADHD

Answer 34

-Often fidgets with hands or feet or squirms in seat leaves seat in classroom or in other situations in which remaining seated is expected -Runs about or climbs excessively in situations in which it is in appropriate -Has difficulty playing or engaging in leisure activities quietly -Often on the go or as if driven by a motor -Talks excessively -Often blurts out answers before questions have been completed -Often has difficulty awaiting turn -Interrupts or intrudes on others

Question 35

Implications of ADHD

Answer 35

- 2-5% prevalence - 40-60% develop conduct disorder, delinquency or drug problems, compared to the normal population, where its 16%. - 20% have a learning disorder and end up doing poorly in school. - As adults, are more likely to have interpersonal problems, frequent job changes, traffic accidents, marital disruptions and legal infractions.

Question 36

Causes of ADHD

Answer 36

- D2 and D4 gene and its effect on dopamine receptors - Prenatal complications increase risk of ADHD - High blood levels of lead show higher rates of hyperactivity, distractibility, impulsiveness and problem following simple instructions. - Areas of brain, particularly the frontal lobe, that control arousal and behavioral inhibition Environmental conditions - Changing environments (moving around a lot) and divorce. - Violent and/or irresponsible fathers.

Question 37

Treatment of ADHD

Answer 37

Drug Therapy -Stimulants -Show increases in interpersonal responsiveness and goal-directed efforts, plus decrease in activity level and disruptive behavior. -This also occurs in normal children, however, so there is nothing unique that stimulants have on children methylphenidate or Ritalin. -Increases dopamine activity in the brain Side effects: insomnia, headaches, nausea, non-lasting effects (no long-term benefits) -Premoline or Cylert. Also acts on dopamine system ``` Behavioral Therapy -Operant conditioning -Rewarding good behavior Not as effective as drug therapy, though combination of the two is best. ```