Childhood and Adolescent Disorders

Question 1

Developmental psychopathology

Answer 1

• Refers to the study of how disorders arise and change with time
  
  • deviation from age-appropriate norms
  • exaggeration of normal developmental trend
  • behaviors that interfere with normal developmental processes

Question 2

Factors that make it difficult for parents to clearly identify their child’s symptoms

Answer 2

• make assumptions
• relate their own experience to what they’re seeing in the child
• ask them to focus on what they’re observing directly

Question 3

What factors are important to keep in mind when assessing and treating children/adolescents?

Answer 3

* age appropriate language
Importance of multiple sources
* child/adolescent
* parents/caregivers
* school/teacher

Question 4

Things to do when interviewing children

Answer 4

• Keep in mind developmental level
  * ability to communicate
  * ability to recognize symptoms and problems
  * experience of symptoms (often different from adults)
  
  • Motivation and desire for treatment

Question 5

Features of childhood anxiety disorders

Answer 5

• Physiological symptoms
• Behavioral and somatic complaints rather than cognitive ones
• Center on specific objects or events (sometimes imaginary)
  
  • Monsters, thunderstorms
  • Triggered by a current situation or events
• Cognitive maturity
  
  • adult anxiety requires the anticipation of future negative events

Question 6

Features of Childhood mood disorders

Answer 6

• Before the 1980’s few clinicians believed young children could be severely depressed.
• No sex different in rates of depression before 13; 2:1 females by 16
• Cognitive factors

Question 7

Disruptive Mood Dysregulation disorder

Answer 7

• Core symptom=chronic, severe persistent irritability
• Severe temper outbursts grossly our of proportion for situation
  
  • Inconsistent with developmental level
• Outbursts 3+ times per week
• Present 12 or more months, never a period of more than 3 months without all 4 symptoms
• Not diagnosed for first time before age 6 or after age 18
  
  • onset before age 10
• Outbursts and mood present in at least two settings

Question 8

Antidepressants and youth

Answer 8

• Suicidal thoughts and attempts may increase in 2-4% of youth
• Overall risk is reduce for the majority of youth (30% decrease in youth suicides up to 2004 as prescriptions to youth soared)

Question 9

Treatment for depression in youth

Answer 9

• CBT alone less effective for adolescents than for adults

* CBT + antidepressants most effective

Question 10

Oppositional defiant disorder

Answer 10

• argue repeatedly with adults, lose temper, swear, feel great anger and resentment, blame others for their own mistakes
• Typically begins by 8 years of age
• 2-16% of children
• More common in boys before puberty and equal in boys and girls after puberty
• Developmental progression of noncompliance
  
  • Most children grow out of this phase by the time they begin K or 1st grade
  • Often see noncompliance at home but not in the school setting

Question 11

Conduct disorder

Answer 11

• violate others’ basic rights by cruel or criminal behavior
  Conduct disorder usually begins before age 10 and is exhibited by 6-16% of boys and 2-9% of girls
  1/3 of those referred to child guidance clinic

Question 12

ODD and CD etiology

Answer 12

• Family environment
  
  • Frequent conflict and hostility
  • Poor parenting strategies
  • Parental rejection, neglect, abuse
  • More permissive and inconsistent
  • More likely to reinforce inappropriate behaviors and ignore or punish prosocial behaviors

Question 13

CD also attributed to

Answer 13

• genetic and biological factors
• antisocial traits
• drug abuse
• poverty

Question 14

Treatment for ODD and CD

Answer 14

• Treatment more effective with children under 13
• Residential programs, school based interventions, and skill training techniques have limited effectiveness
• Drug therapy is widely used but has limited research support
• Institutionalization in juvenile detention centers increases conduct problems
• Parent-child relationship training most common tx for young children

Question 15

Parent-child relationship training (PCIT)

Answer 15

• Evidence based tx for bx problems in children ages 2 to 7
• Goals
  
  • improve parent-child relationships
  • improves bx management of parents
• 2 phases:
  
  • child-directed interaction
    
    • increase parental responsiveness and establish a secure, nurturing relationships
  • parent-direction interaction
    
    • improve parental limit setting and consistency in discipline

Question 16

ADHD

Answer 16

• Symptoms maladaptive and age inappropriate
• Identify type: combined, inattentive, hyperactive-impulsive
• inattention
  
  • sustained more important than focused
  • susceptible to distractions
• Hyperactivity/impulsivity
  
  • psychomotor agitation
  • constant movement
  • interruptive
  • poor decision-making
  • problems with delay of gratification

Question 17

ADHD associated features

Answer 17

• co-morbid learning disorders and ODD/CD
• Educational and occupational achievement less than ability
• Disciplinary problems (legal as adults)
• Social/relationshp problems
• clumsiness, slow reaction times
• greater risk for substance use disorders
• focus and attention can be context dependent
• typically perform better in highly structured environments

Question 18

ADHD at preschool age

Answer 18

• more negative temperament and greater emotional reactivity

* more often out of their seats, wandering, classroom

Question 19

ADHD at elementary age

Answer 19

• problems with hyperactivity/impulsivity persists
• problems with oppositional and socially aggressive bx
• overall adaptive functioning falling significantly below their intellectual ability

Question 20

ADHD in high school

Answer 20

• 50-80% continue to have difficulties
• 40-60% also meet criteria fro CD
• negative school outcome - 10-30% quit

Question 21

ADHD in adulthood

Answer 21

• 50-65% continue to experience difficulties
• greater difficulties with social skills, unstable marriages, low self-esteem, poor work records, difficulties with supervisors, overall lower SES attainment

Question 22

ADHD etiology

Answer 22

• males 4x>females
  
  • 30% chance of having ADHD if a first degree family member carries dx.
• genetic component
• food additives- very limited support
• maternal smoking associated with risk

Question 23

ADHD treatment

Answer 23

• stimulant medication
  
  • slow onset, sustained effect
  • ritalin, adderall, concerta, strattera
• behavioral
  
  • structure routine
  • consistency in discipline
  • social skills training

Question 24

Autism Spectrum Disorder

Answer 24

developmental disorder marked by extreme unresponsiveness to others, severe communication deficits, and highly repetitive and rigid behaviors, interests, or activities.

• Deficits in social communication and social interaction
  
  • social/emotional reciprocity
  • nonverbal communication
    
    • delay/lack of spoken language and gestures
    • repetitive and idiosyncratic use of langue (echolalia)
  • Problems developing, maintaining, and understanding relationship
    
    • problems initiating/maintaining conversation
    • lack of interest in peers
• Restricted, repetitive, stereotyped behavior, interests
  
  • restricted interest
  • inflexible routines
  • stereotypes/repetitive movements
  • hypersensitivity to sensory input

Question 25

Autism etiology

Answer 25

• no support for “refrigerator moms”
• vaccinations- no support
• genetic factors
• prenatal difficulties or birth complications
  
  • older age of father
• brain differences
  
  • increased brain volume and white matter
  • structural brain differences: amygdala, brain stem
  • reduced frontal lobe activity

Question 26

Autism treatment

Answer 26

• behavior therapy
  
  • Applied behavior analysis (ABA)
    
    • shaping
    • modeling
    • conditioning
  • Parent training
  • medication
    
    • not effective for core features of autism
    • may help with some of the secondary behavioral problems

Question 27

Separation Anxiety Disorder

Answer 27

marked by excessive anxiety, even panic, whenever the person is separated from home, a parent, or another attachment figure.

Question 28

Theory of Mind

Answer 28

awareness that other people base their behaviors on their own beliefs, intentions, and other mental states, not on information that they have no way of knowing. (undeveloped in autism)

Question 29

deficiencies in joint attention

Answer 29

sharing focus with other people on items or events in one’s immediate surroundings, whether through shared eye-gazing, pointing, referencing, or other verbal and nonverbal indications that one is paying attention to the same object. (limited in autism)