Childhood Disorders Flashcards

Question

What is the psycho and social etiology of depression and anxiety?

Answer 1

Psycho Same as adults *Perfectionism (how different for children?) (how is perfectionism different for kids than for adults? ^- there is a lot more external influence. More people look at you and tell you to be good you need to do all these things. The standard for you to be good and loveable are very set by your parents. ^- Perfectionism is very often rewarded by parents and teachers. Perfectionists become so afraid of failing that they become less creative and more Complient ^- as a perfectionist you get so much reinforcement in your life) Social Depressed parent (if your parent has depression (these studies are done with moms)) * 2-3x more depression * 15% to 45% lifetime risk Critical parent (Others same as for adults) (- more critical they are the more hopeless you feel)

Answer 2

Formal operations (adolescence) * Abstract, complex thought “Life is meaningless” (- start to develop more abstract thoughts such as life is meaningless) * Egocentrism “No one understands” * Cognitive inflexibility “Nothing will ever change” (- kids get these believes about themselves that this is the kind of person that I am and when they have that believe about themselves it becomes more fixed and it is harder to treat) * Metacognition “I’m just a depressed person”

Answer 3

Children Somatic complaints, psychomotor retardation Greater overlap with anxiety Adolescents Hopelessness, hypersomnia, weight changes

Answer 4

Ages 12-17: 2nd leading cause of death Ages 5-14: 5th leading cause of death

Answer 5

Bio * SSRIs and suicide in youth? (Idea is that sometimes giving children SSRI's can increase suicide risk - energy that you get early in treatment gives you the energy to do what you wanted to do - side effects depending on the kind of SSRIs you take) Psycho * CBT * Behavioural activation Social * Interpersonal Therapy (IPT) (this tends to work very well for teenagers with depression)

Answer 6

Attention-Deficit/Hyperactivity Disorder (ADHD) Conduct Disorder (CD)

Answer 7

1%-7% of population (- although it is increasing much more in the past 5 years because more research is being done) 4:1 boys : girls (number is still pretty uneven - because girls with ADHD tend to be more compliant and do not cause a disruption in class) 60% persistent (ADHD as adults) (this is shifting, it is becoming that if you got it you got it - evidence that kids with mild ADHD symptoms they can grow out of. This is especially true for hyperactivity symptoms)

Answer 8

Subtypes: 1. Inattentive 2. Hyperactive-impulsive 3. Combination

Answer 9

Hyperactivity Forgetfulness Poor impulse control Distractibility “Run by a motor” a lot of the time ADHD brain is the basis for a lot of other things on top of it. It is very common to see ADHD related anxiety

Answer 10

Russell Barkley ADHD is a disorder of: * Self-regulation * Executive function (He considers ADHD a disorder of self-regulation. The idea is that ADHD is really about executive function but it effects all different symptoms not just cognitive) Presentation * Issue is performance (not skill)(- can look like a lack of skill because the performance is not a based on the real skill level. Someone could have the skill level but can just not have the executive function to do it) * Low response inhibition (- a lot less response inhibition - the inattentive types tends to have hyperactive thoughts so it is not inattention it is too much attention) * Time-blindness (- being too involved in whatever you are involved in and not having a sense of how the world is moving on outside of you) * Periods of hyper-focus (DA) (- this is the good part - where you can learn a new skill in a short period of time because you are into it - state of flow ) * Difficulty with transitions

Answer 11

Chronic neurological “disorder” Variety of treatments to manage symptoms (- a lot of treatments to manage responses to an environment that is not flowing with ADHD) Also benefits of ADHD (tends to be a calmer feeling in crisis - when things are more stimulating things tend to calm )

Answer 12

Genes >30% have family member with ADHD NTs decreased DA (one of the issues with ADHD is that there is generally low dopamine levels - so you become a sensation seeker ) Pre-perinatal stress Cocaine use Birth complications (some cocaine use and birth complication but it is not really psycho social, it is mainly genetic - very light of the psycho social)

Answer 13

Not much Family adversity & disorganization Weak correlation (Directional relationship?)

Answer 14

Hyperactivity-impulse control: * Poor connections between amygdala & PFC (impulse control) * Underactive Behavioural Inhibition System (BIS) * Underarousal theory (- i need to feel something so I am going to do things that are going to make me feel things)

Answer 15

Inconsistent attention: (these work together to control and direct attention. What happens is that these are all interconnected with the ability to sense things. They are a gate when they are active. They filter out information that is not important. What happens with ADHD is that they are underactive so there is attention everywhere, it takes very little to have your attention grabbed. You are very open to stimuli, external and internal. You are more open to it because the gates are under functioned.) Striatum + frontal lobes + posterior periventricular region (controlling & directing attention) * Interconnected with sensory cortices * Act as a gate Important information registers Irrelevant “noise” filtered out

Answer 16

Inconsistent attention: Under-functioning “gates” unable to filter out  stimuli Sensory cortices flooded with incoming messages → High blood flow (esp. to vision & sound input areas) we see a lot of activation in the sensory areas

Answer 17

Medication is most effective in managing symptoms Methylphenidate (Ritalin, Concerta) * Redistributes blood flow in brain * Less to structures involved in vision & hearing * increased function of striatum, frontal lobes, & posterior periventricular region * increased availability of DA * Increased focus, inhibitory control, regulation of extraneous motor behaviour (e.g., fidgeting) * Reduce symptoms in 60%-80% of school age children53

Answer 18

Cognitive * Externalize executive functioning (- so you have a reminder - having your schedule and your little reminders so that you do not need to keep it in your working memory) Behaviour * Reward systems, frequent breaks (- if you have ADHD you get this accommodation a lot) * Environmental adjustment & accommodation necessary (- it is critical to get the necessary accommodation - ADHD brains work differently ) Behavioural parent (& teacher) training * Behavioural programs emphasizing: time-limited attention, emotion regulation, & rule following (the amount of negative to positive messages ADHD kids get to "normal kids" is a lot more negative )

Answer 19

Violation of rules & disregard for basic rights of others Baby anti social personality disorder - but does not always have to do this. But need this to have ASPD 1. Aggression to people and animals 2. Destruction of property 3. Deceitfulness or theft 4. Serious violation of rules

Answer 20

Comorbidity * ADHD (- if it is coming from ADHD it is likely based on emotion dysregulation or under arousal theory) * Substance abuse * Anxiety & depression common Prevalence (ages 4-16) * 8% of boys * 3% of girls (- it is more behavioral so you will see this activity more in boys) Course 1. Childhood onset: boys > girls * “Life course persistent” (- this is sticking around. the traits are likely to stay put) 2. Adolescent onset: boys = girls * “Adolescence limited” (maturity gap?) (- boys and girls tend to be even and it tends to only last in adolescent and goes away in adulthood)

Answer 21

Genes 50% heritability (antisocial behaviour) MAOA gene – “the warrior gene” Breaks down 5-HT, NE, DA decrease MAOA → aggression (- this gene breaks down some of the NT. If they are not broken down as well or as efficiently you will have more aggression.) Gene x environment correlations (Passive rGEs - parent is creating an environment that is more likely to have the kid feel certain ways - parent created environment that promotes certain behaviors) Passive rGEs (parent-created) Active rGEs (kid-created) (- the kid seeks out other peers and other influences and activities that will put them in situations that will lead them to be more agressive)

Answer 22

Genes: What is inherited? * Callous-unemotional style * Executive dysfunction Poor problem-solving & planning ability → Poorly thought out, maladaptive reactions to distress & conflict * High emotional reactivity * Sensation-seeking Chronic underarousal → stimulus-seeking

Answer 23

Empathy & perspective-taking deficits Hostile attributional bias - you think if someone does something to harm you you think that they did it to purposely harm you

Answer 24

Modeling Inter-parent discord (- more fights that happen the more angry aggressive expressions you are around are going to effect conduct disorder - parents fighting) Overly harsh discipline (often to parental urge is to discipline harder. This teaches the kids to be sneakier and gives them more resentment - the harsher the discipline the worse the disorder tends to become ) Inconsistent contingencies (e.g., based on mood) (- if you are in a bad mood i am going to punish you more severely - inconsistency of how you punish is going to not make sense to the kid and they think they cannot trust people) Low involvement, weak bonding, poor monitoring Differential attending/rewarding (coercive process) (- kid does something I do not like the kid gets mad and yell and you say whatever and you leave ^- the kid gets rewarded by getting mad (they get mad and you leaving is the reward))

Answer 25

Antipsychotics Stimulant medication?

Answer 26

Harsh discipline → increases delinquency Family intervention * Parent management training (- if the parent does not change the way they are responding the kid is not going to get better - the parent piece is super fundamental, often times if we change the parental things we do not need any intervention with the kid themself ) Multisystemic treatment (MST) * Involves child, family, school, peer group * Often used instead of incarceration (it is so expensive so it is not really used unless incarceration is the only other option)

Answer 27

Relationship-building (1:1 time) Attending (& active ignoring) (- you want to actively ignore things that are not a problem such as swearing) Effective instructions (- you do not want to tell them something like "go be better" you need to be more specific ) Praise/reward system (shaping) (- you need to praise them for better behavior - ex: you should praise them for yelling at you if they usually hit you) Consequences (privilege removal, attn withdrawal) (- you do want to do much more privilege removal) (you want them to care about your reinforcement - they can care what is thought about them and reject them - you NEED to have a lot of warmth which can be very hard for having a kid like this)

Answer 28

Aspects of: CBT, case management, family systems treatment * “Fit” between problem and systemic context * Encourage responsible behaviour in family members * Require daily/weekly effort from family