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Abnormal Test 4 > Childhood/Adolescence Disorders > Flashcards

Childhood/Adolescence Disorders Flashcards

1
Q

Prevalence of childhood/adolescence disorders

A

Serious emotional/behavioral problems: 1 in 5

No treatment - 2/3 of kids

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2
Q

major types

A
  1. Internalizing disorders
  2. externalizing disorders
  3. Neurodevelopmental disorders
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3
Q

emotional symptoms for internalizing disorders

A
  1. Heightened reactions to trauma, stressors, or negative events & difficulty regulating emotions
  2. Often lead to substance use & suicide
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4
Q

major types of internalizing disorders

A
  1. Anxiety, trauma, & stressor-related disorders
  2. Depressive disorders
  3. Nonsuicidal self-injury
  4. Pediatric bipolar disorder
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5
Q

Most prevalent childhood disorder in anxiety, trauma, and stress related disorders

A
    • 32%
      1. School Phobia: Fear of attending school
      2. Separation Anxiety Disorders - severe distress about leaving home, being alone, or being separated from a parent
      3. selective mutism - consistent failure to speak in certain situations
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6
Q

Early life PTSD

A

Recurrent, distressing memories to trauma event

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7
Q

Early Life PTSD-symptoms

A
  1. Distressing dreams, ↑ physiological/psychological reactivity, dissociative reactions
  2. Increase Social withdrawal, ↓ positive affect, & increase disinterestin previously-engaged activities
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8
Q

Early Life PTSD-Lifetime prevalence

A

Girls 8% > boys 2.3%

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9
Q

Early Life PTSD-Effective treatments

A

Trauma-focused cognitive-behavioral therapies

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10
Q

Early Life: Depressive Disorders - Characteristics

A

Negative self-concepts & self blame/criticism

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11
Q

Early Life: Depressive Disorders - Early-onset depressive symptoms

A

More chronic and severe course

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12
Q

Early Life: Depressive Disorders - Evidence-based treatment

A
  1. Individual, group, or school-based CBT
  2. SSRIs: ↑ Suicidality
    Benefits may outweigh risk
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13
Q

Nonsuicidal Self Injury (NSSI)

A

def. Intentional, self-inflicted injury w/o suicidal intent
1. Negative affect/cognitions & self-harm preoccupation
2. Preoccupied with self-harm
3. Expect mood will improve after NSSI

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14
Q

Nonsuicidal Self Injury (NSSI) - Prevalence

A

14-17%

  1. Small percent repeatedly engage in NSSI
  2. Increase risk for attempted suicide
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15
Q

Nonsuicidal Self Injury (NSSI) - Treatment

A
  1. Teach problem-solving, coping, and emotional regulation

2. Improve emotional expression and interpersonal skills

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16
Q

Pediatric Bipolar Disorder (PBD)

A
  1. Similar to adult bipolar disorder
  2. Depressive & energized episodes
  3. Recurrent depression, elevated mood, and rapid mood changes
  4. Decraesed need for sleep, increase activity/distractability, etc.
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17
Q

Pediatric Bipolar Disorder (PBD) - Prevalence

A

3%

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18
Q

Pediatric Bipolar Disorder (PBD) - Etiology

A

↑ Responsiveness to emotional stimuli, ↓ amygdala volume, and other brain abnormities, etc.

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19
Q

Pediatric Bipolar Disorder (PBD) - Treatment

A

Medications with psychosocial treatment

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20
Q

Attachment disorder

A

Early stressful environments that lack predictable parenting & nurturing - Affects emotional attachment and social relationships

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21
Q

Attachment disorder types

A

Reactive attachment disorder (RAD)

Disinhibited social engagement disorder (DSED)

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22
Q

Reactive Attachment Disorder - Symptoms

A
  • Inhibited & avoidant social behaviors
  • Reluctance to seek/respond to attention or nurturing>Little trust that others will attend to their needs
  • Limited positive emotion>Irritability, sadness, or fearfulness in adult interactions
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23
Q

Reactive Attachment Disorder - Etiology

A

Using avoidance/ambivolence as psychological defence

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24
Q

Disinhibited Social Engagement Disorder -symptoms

A
  • Indiscriminate & superficial attachments>Socializes easily, but indiscriminately
  • Desperation for interpersonal contact>Superficial attachment to strangers/aquaintances
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25
Q

Disinhibited Social Engagement Disorder - Etiology

A
  • History of harsh punishment or inconsistent parenting>Emotional neglect and limited attachment
  • Most Vulnerable>Exposure to maltreatment or maternal psychiatric hospitalizations
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26
Q

Attachment disorders - course

A

depends on:

  1. Severity of deprivation/abuse & caregiving disruptions
  2. Subsequent events in child’s life
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27
Q

Attachment disorders - prognosis

A

RAD symptoms – can disappear with treatment

DSED symptoms – more persistent

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28
Q

Attachment disorders-effective intervention

A
  • Provide stable and nurturing environment

- Build interpersonal trust and social skills

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29
Q

Externalizing disorders

A

Sometimes called disruptive behavior disorders

Symptoms are socially disturbing/distressing to others

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30
Q

Externalizing disorders - examples

A

Disruptive mood dysregulation disorder
Oppositional defiant disorder
Conduct disorder

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31
Q

Externalizing disorders - diagnosis

A

Persistent pattern that is atypical for child’s gender, age, and developmental level
At least 1 year
Impairs social, academic, or vocational functioning

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32
Q

Disruptive Mood Dysregulation Disorder (DMDD) - symptoms

A

Chronic irritability & significantly exaggerated anger reactions
Ex. Temper tantrums

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33
Q

Disruptive Mood Dysregulation Disorder (DMDD) - course

A

Begins in early childhood
persists beyond age 6
Predictive of later depressive & anxiety disorders

Rule out pediatric bipolar disorder
Symptoms may overlap

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34
Q

Oppositional Defiant Disorder - symptoms

A

Negativistic, argumentative, & hostile behavior
Ex. Losses temper, defies parents/adults
Behaviors directed at parents, teachers, & authority figures
No serious violation of societal norms

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35
Q

Oppositional Defiant Disorder - components

A

Negative affect/emotions

Oppositional behaviors

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36
Q

Conduct Disorder - symptoms

A

Persistent behaviors that violates others’ rights - Serious rule violations and illegal behavior: theft, deceit. Etc.
Callous & unemotional subtype: APD in adulthood - Aggression, cruelty, manipulation and superficial emotions, also Minimal guilt, remorse, or empathy

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37
Q

conduct disorder - prevalence

A

-Displays inattention & hyperactivity – 50%
-Gender differences:
Males: confrontational aggression - Eg. Fighting, vandalism
Females: Truancy, substance abuse, or chronic lying

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38
Q

externalizing disorders - biological dimension

A

Brain abnormalities – decrease social information processing
↓ Amygdala activity to fear situations
“Low MAOA” + childhood maltreatment
Decrease automatic nervous system activity ↓ ANS activity
Cortisol levels  Stress levels higher levels are more aggressive, and lower levels are more sneaky

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39
Q

externalizing disorders - psychological dimension

A

Difficult temperament – e.g. irritable, impulsiveness
Underlying emotional issues - e.g. anxiety disorders
Depression frequently coexists with ODD and DMDD

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40
Q

externalizing disorders - social and sociocultural dimension

A

Family & social context: Play large role
Large families, marital breakdown, Economic stress, Crowded living conditions
Harsh or inconsistent discipline
Parent-child conflict and power struggles, Maternal or peer rejection, May result form difficult temperament

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41
Q

Externalizing disorders - treatments

A

Focus on family/social context of behaviors & deficits in psychosocial skills-
CD (conduct disorder): Very difficult to treat
Tend to be self-focused, and what is right is what makes me happy
More effective if introduced-
Before chronic patterns of disruptive behaviors are established ~ Ex. A counselor or teacher, etc. notices and refer to therapist or help

42
Q

Externalizing disorders - treatment techniques

A

Parent-focused & child management techniques:
-Assertiveness-training and child anger management (act on their feelings since they cannot understand their feelings)
-Increased skills in empathy, communication, social relationships, and problem solving
Mobilizing adult mentors: Not only for kids, but for the parents too!

43
Q

Neurodevelopmental Disorders - symptoms

A

Impairment in development of brain & CNS - Born with some abnormalities, so we see things that are out of their control
Evident early in child’s life

44
Q

Neurodevelopmental Disorders - examples/types

A

-Tics & Tourette’s disorder - So significant that it impacts their life - Ex. Making fun of the child, etc.
-Attention-deficit/hyperactivity disorder
-Autism spectrum disorders
Intellectual disability & learning disorders

45
Q

Tics

A

Involuntary, repetitive movement/vocalization

46
Q

Motor tics

A

Eye-blinking, facial-grimacing, head-jerking, food tapping, or flaring of the nostrils
Contracting muscles in shoulders or abdomen

47
Q

Vocal tics

A

Coughing, grunting, throat clearing, or sniffling

Sudden, repetitive and stereotyped outburst of words

48
Q

Tics - general

A

Short-term suppression is possible
But results in subsequent increase in tic
Some report feeling tension related build prior to tick, followed by sense of relief after tic occurs
Stress can increase frequency & intensity

49
Q

tics - types

A

“Provisional” tic disorders: 2.6%, Less than 1 year

“Chronic” motor or vocal tic disorders: 3.7%, More than 1 year

50
Q

Tourette’s Disorder - symptoms

A
  • Multiple motor tics & 1 or more vocal tics: More than 1 year, Symptoms can be severe or mild
  • Coprolalia (e.g., involuntary swearing) or motor movements involving self-harm – 10%
51
Q

Tourette’s Disorder - course

A
  • Usually symptoms occur by ages 7-10 years

- Increase symptoms in middle teen years, but decrease early adulthood, Complete remission – 8%

52
Q

Tourette’s Disorder - Comorbidity issues

A

-Poor anger/impulse control, social skills (embarrassment), ADHD, OCD (could occur when there is a schedule and predictable)

53
Q

neurodevelopment disorders - Etiology

A

Genetically transmitted
Similar physiological mechanisms to OCD
Involvement of basil ganglia and orbital frontal cortex
Possible involvement of Neurotransmitters

54
Q

neurodevelopment disorders - Treatment

A

Psychotherapy can help with distress
Habit reversal technique
Teaching behavior that is incompatible with tic is effective
Antipsychotic medication used for sever tics

55
Q

Attention-Deficit/Hyperactivity Disorder (ADHD) - symptoms

A

Persistent inattention and/or Impulsive, hyperactive behavior
Impacts social, academic, or occupational activities
Poor regulation of attentional processes

56
Q

Attention-Deficit/Hyperactivity Disorder (ADHD) - course

A

Before age 12 & persists more than 6 months

Symptoms tend to improve in late adolescence

57
Q

Attention-Deficit/Hyperactivity Disorder (ADHD) - prevalence

A

8.7%
Gender = boys (2x) > girls
Poverty status = 4x greater risk

58
Q

Attention-Deficit/Hyperactivity Disorder (ADHD) - biological dimension

A

-Highly heritable:
~No specific genes but: Rare inhereted gene mutations, Chromosomal DNA deletions and duplications, Genes affecting regulation of dopamine and glutamate
~Gene x gene or gene x environment interaction - Could be two types of mutation or the gene mutation and the environment you live in

59
Q

Attention-Deficit/Hyperactivity Disorder (ADHD) - psychological dimension

A

Interpersonal conflict

60
Q

Attention-Deficit/Hyperactivity Disorder (ADHD) - social and sociocultural dimensions

A

-Sociocultural & social adversity including: Family stressors, Low social class, Foster care placement
-Cultural & regional expectations
Parenting styles

61
Q

Attention-Deficit/Hyperactivity Disorder (ADHD) - treatment (medications)

A

stimulants: Ritalin: most evidence-based support - Decrease core symptoms – 70%
- Neurotransmitter functioning & neurological activation in frontal cortex
- Increase rates of stimulant medication use in U.S.

62
Q

Attention-Deficit/Hyperactivity Disorder (ADHD) - biological dimension (pre/neo/postnatal issues)

A
  • Prenatal issues: Smoking & drug/alcohol abuse during pregnancy: More likely to report with child that has ADD/ADHD
  • Neonatal issues: Prematurity, Oxygen deprivation during birth, Very low birth weight
  • Postnatal issues: Lead & PCB exposure, Viral infections, meningitis, & encephalitis, Possible involvement of food additives & unhealthy diet
63
Q

Attention-Deficit/Hyperactivity Disorder (ADHD) - biological dimension neurological mechanisms

A
  • ↓ Prefrontal cortex activity – gets info about social situation and see what we should be doing and do it
  • Differences in brain structure & circuitry in frontal cortex, cerebellum, and parietal lobes
  • Low dopamine levels
64
Q

Attention-Deficit/Hyperactivity Disorder (ADHD) - treatment (behavioral and psychosocial)

A
  • Highly effective
  • Modifying environment & social context can enhance feelings of competence, motivation, and self-efficacy
  • Coordination of all services results in most successful interventions
65
Q

Autism Spectrum Disorder - Symptoms (deficits)

A

-Atypical social-emotional reciprocity: Limited interest in social interaction
-Atypical nonverbal communication: Limited eye contact, meaningful gestures, and facial expressions
Difficulties developing/maintaining relationships: Lacks interest in others and fails to recognize people’s identity or emotions

66
Q

Autism Spectrum Disorder - symptoms in order to be diagnosed

A

at least 2 of the following:
-Repetitive speech, movement, or use of objects: Echolalia and
“Stimming”
-Intense focus on rituals or routines, strong resistance to change
-Intense fixations or restricted interests: Ex. Focuses on one subject, object, or activity
-Atypical sensory reactivity: Lack of reactivity, over-activity, or focuses on sensory aspects of objects

67
Q

Echolalia

A

repetition of vocalization by others

68
Q

“Stimming”

A

repetitive hand motions

69
Q

Autism Spectrum Disorder - prevalence

A

: 1 in 100-110 children
Gender: Boys (4x) > girls
Severity Spectrum: mild – severe

70
Q

Asperger’s Syndrome

A

Mild characteristics: Intense focus on narrow interests, Eccentric one-sided social interactions
DSM-5: no longer separate diagnosis

71
Q

Autistic Savants

A

patients with ASD who perform exceptionally well on certain tasks

72
Q

Autism Spectrum Disorder - biological dimenstion in general

A

Unique patterns of metabolic brain activity
Abnormally high levels of serotonin - Males and high-functioning individuals
Differences in brain anatomy & connectivity - Brain regions associated with autistic traits
Accelerated growth of amygdala & head

Innate vulnerability triggered by environment: Environmental toxins and nutritional deficits, Changes in the immune system, Low birth weight and closely spaced pregnancies

73
Q

Autism Spectrum Disorder - biological dimenstion genetic factors

A

Genetic susceptibility – clear evidence
Genetic mutations implicated in familial autism
Autistic traits have high Heritability
Monozygotic twin estimates - Males (73%), females (87%)

74
Q

Autism Spectrum Disorder - Psychological & Social Dimensions

A

Play a role in manifestation of symptoms but, ASD is primarily influenced by biological factors

Rarely make eye contact, social connectedness, bid (seek) for attention
Parental efforts at connection are ignored
Unusual behaviors further isolated child
High stress levels for family due to ASD

75
Q

Autism Spectrum Disorder - treatment

A

Most retain diagnosis and require support for life

76
Q

Autism Spectrum Disorder - treatment Medications

A
  • To decrease anxiety, repetitive behaviors, and hyperactivity
  • Oxytocin for mild ASD -> outcome are still up in the air
  • Minimally effective: may be harmful, Only risperidone is FDA approved
77
Q

Autism Spectrum Disorder - treatment cognitive-adaptive functioning

A
  • Higher levels: better prognosis than those with intellectual disabilities and severe autistic symptoms
  • Significant recovery is linked to intense early intervention
78
Q

Autism Spectrum Disorder - treatment comprehensive treatment programs

A

Development of more functional skills

After intensive treatment, some no longer meet ASD diagnosis

79
Q

Autism Spectrum Disorder - treatment interventions with most significant gains

A

Increase social communication & environmental enrichment
↑ Appropriate attention & response to social stimuli
Prevent repetitive behaviors (decrease)
Sustained practice of weaker skills
Reduce environmental stress
Improve sleep & nutrition

80
Q

Intellectual Development disorder (IDD)

A

Limited intellectual functioning & adaptive behaviors:

  • Significantly below average intellectual functioning-IQ score of 70 or less
  • Deficiencies in adaptive behavior-Lower than expected based on age or cultural background
81
Q

IDD Diagnosis

A

Low IQ w/ impaired adaptive functioning

4 severity levels: Mild-Profound

82
Q

Mild IDD

A

IQ = 50-55 to 70
Mildly affects daily living & social interaction
Adaptive difficulties in conceptual and academic skills
May need assistance w/ job or independent living skills
Some marry and raise children

83
Q

Moderate IDD

A

IQ = 35-40 to 50-55
May have functional self-care skills & communicate basic needs
Can read a few basic words
Lifelong support & supervision required
Supervised meal preparation, sheltered work

84
Q

Severe IDD

A

IQ = 20-25 to 35-40
May recognize familiar people
Limited communication skills
Lifelong support required

85
Q

Profound IDD

A

IQ < 20-25

Similar to severe IDD, but even more extensive care needs

86
Q

Prevalence of IDD

A

~1% of students in public schools
Increase risk: Low & middle income countries
Co-existing conditions are common
One fourth have seizure disorders

87
Q

IDD Etiology in general

A

Depends on level of ID
Mild IDD: Often idiopathic (no known cause)
Pronounced IDD: Genetic factors or brain injury & abnormalities

88
Q

IDD Biological Dimension

A
  • No known underlying cause? Genetic factors – likely unknown
  • Genetic variations: Normal distribution of traits: Upper vs. lower range
  • Genetic abnormalities: Inheritance of single gene - Fragile X syndrome – most common (mild to severe ID), Chromosomal abnormalities - Down syndrome (most common)
89
Q

Down Syndrome

A
  • Extra copy of chromosome 21- Originates during gamete development, ↑ Mother’s age = increase risk
  • Majority w/ DS: Mild to moderate IDD - Many have jobs and live semi-independently with support
  • Medical interventions improve outcome, but significant risks remain
  • Prenatal detection of DS via amniocentesis - Procedure carries some risk to mother and fetus
90
Q

Nongenetic Biological Factors

A
  • Prenatal period: Susceptible fetus
    Viruses/infections, radiation, & poor nutrition, Drugs & alcohol - Fetal alcohol spectrum effects and fetal alcohol syndrome
    -Perinatal period: Birth trauma, prematurity, & low birth weight
    -Postnatal period: Head injuries, brain infections, & tumors, Prolonged Malnutrition & exposure to environmental toxins including lead
91
Q

Psychological, social, and sociocultural dimensions for IDD

A

-Genetics X environmental effects: Effects of low SES
Impacts nutrition and health care, Parents w/ mild IDD, Long-term effects of prematurity
-Enriching & encouraging home environment can help with children with IDD as well as ongoing education intervention

92
Q

Learning Disorders - differences in the DSM-5

A

No longer separate types

93
Q

Learning Disorders - Coded specifiers

A

reading, writing, and math

94
Q

Learning Disorder for Reading

A

Dyslexia

95
Q

Learning Disorder for Math

A

Dyscalcia

96
Q

Learning Disorder for Written expression

A

Dysgraphia

97
Q

Specific Learning Disorder

A

Academic disability & skills deficits

↓ Academic achievement & daily living activities

98
Q

Learning Disorders - Prevalence

A

Students in public schools - ~5%

Gender – boys (2x) > girls

99
Q

Learning Disorders - Etiology

A
  • Little is known about precise causes - Appear to have slower brain maturation, Lifelong differences in neurological processing of information related to basic academic skills
  • Similar to biological explanation for IDD & ADHD: Runs in Families, suggesting genetic component
  • Identical twins: 100% concordance rate
100
Q

Neurodevelopmental Disorders - intervention

A
  • Build skills and develop fullest potential possible

- Intervention & support should begin in infancy and extend across the life span

101
Q

Neurodevelopmental disorders - childhood intervention

A
  • Individualized home- or school-based programs with parent involvement is very important in early intervention
  • School services that are specialized to meet child’s needs and maximize learning, improvement rates decrease once programs are completed
102
Q

Neurodevelopmental disorders - adulthood intervention

A
  • Programs focusing on Specific job skills
  • Institutionalization is rare, but many live without family
  • “Least restrictive environment” possible: As much independence and personal choice as is safe/practical as well as most normalized living arrangements vary form setting to setting

Abnormal Test 4 (4 decks)

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