Childhood Disorders Flashcards
1
Q
Pros of classification system
A
- enables growth of body of knowledge about particular phenomenon incl as accurate a clinical description as possible (aetiological factors, course, management plans)
- allows development of epidemiological data that’s key for planning service provision
- gives common clinical language
2
Q
Problems with current classification system
A
- poor inter-rater reliability esp when not using standard, structured interviews
- co-morbidity
- developmental issues: how to detect disorders in young children with mental age significantly below chronological age
3
Q
internalising
A
- crying, withdrawal, worrying
- more problematic for child and less visible for parents/teachers
4
Q
externalising
A
- behavioural problems (hyperactivity, aggressive and conduct problems)
- often results in referral
5
Q
1.5-5 yr olds: internalising syndrom, mixed, externalising
A
int: anxious, depressed, withdrawn, emotionally reactive, somatic complaints
mixed: sleep problems
ext: aggressive behaviour and attention problems
6
Q
6-18 yr olds: internalising syndrom, mixed, externalising
A
int: anxious-depressed, withdrawn-depressed, somatic complaints
mixed: attention, thought and social problems
ext: aggressive behaviour, delinquent behaviour
7
Q
risk factor categories (4)
A
- predisposing
- precipitating- what triggers onset or worsens difficulties
- maintaining
- protective- prevent further deterioration
8
Q
Personal predisposing factors: Genetic factors
A
- in part contribute to psychological characteristics (eg intelligence)
- genes may contribute vulnerabilities (mood/schizo)
- genetic influence = polygenetic (except for specific syndromes like down, autism)
- research = childhood disorders not unalterably determined by genes
9
Q
Personal predisposing factors: prenatal factors
A
- maternal age (down syndrome)
- maternal substance abuse
- maternal illness (rubella/ AIDS)
- poverty and maternal malnourishment
- secretion of stress hormones
= low birth weight/prem babies which is a risk for intellectual impairment
10
Q
Personal predisposing factors: postnatal complications
A
- neonatal problems resulting in brain damage (anoxia, forceps, breech deliveries)
- prematurity - underdeveloped skull bones = risk of attention problems
11
Q
Personal predisposing factors: physical injuries and chronic illnesses
A
- head injuries (extent of trauma + recovery enviro determine outcome)
- illnesses like asthma, diabetes = stressors that affect context in which child develops
12
Q
Personal predisposing factors: psychological/intrapersonal factors
A
- temperament (easy= attract people, do well and recover from challenges, bad= attachment and relational problems, poor adaptibilty, better outcomes with tolerant responsive parenting)
- intelligence (can use mature defence mechanisms
- self esteem (if low are at risk of developing behaviour problems- look for attention elsewhere so are taken advantage of)
- locus of control
13
Q
Personal Maintaining factors: self regulatory beliefs
A
- learned helplessness
- learned optimism (keeps trying, better adjustment)
- hostile attributions (because of inconsistent and unpredictable parental abuse. contributes to provocative behaviours, possible rejection and isolation that maintains difficulties)
14
Q
Personal Maintaining factors: defence mechanisms
A
- Regulate emotions deriving from conflict between what one desires and consequences of those actions
- promotes high levels of adaptation
- keep unacceptable impulses from conscious awareness
- immature (splitting- either all good or all bad, projection, passive aggression)
- neurotic defences ( repression, denial, displacement, rationalisation)
15
Q
Personal Maintaining factors: coping strategies
A
- how one might choose to cope- more conscious than defence mechanisms
- problem focused coping
- emotion focused coping
- avoidance focused coping
- if dysfunctional it gives short-term relief but in long-term it maintains problems
16
Q
Problem focused coping
A
- aims at problem solving
- functional: when seeking accurate useful information from reliable sources; developing & implementing realistic plan of action;
- dysfunctional: when you seek questionable advice; taking little responsibility for solving problem; basing solution on unrealistic goal; not following thru
17
Q
Emotion focused coping
A
- aims at effective regulation
- functional: when one makes & maintains supportive relationships and processes emotions
- dysfunctional: when one makes/maintains destructive relationships, use of avoidance , drugs, wishful thinking
18
Q
Avoidance focused coping
A
- aims to avoid source of stress
- functional: if one temporarily disengages mentally, engages in distracting activities or relationships
Dysfunctional: when mental disengagement or use of distracting activities/relationships goes on over the long term
19
Q
Precipitating factors
A
- Acute life-stressors
- Illness/injury
- Child abuse
- Bullying
- Lifecycle transitions
- Births or deaths
- Loss of friendships
- Parental stresses
- Moving houses/schools
20
Q
predisposing factors: parent-child factors
A
- attachment
- patterns influenced by parental attunement and responsiveness and child’s temperament
21
Q
Secure Attachment
A
- parents= a secure base from which to explore the world
- child seeks proximity to parent under threat but when it’s gone the child returns to normal activities
- likely to be found where family style is adaptable
- as an adult is secure and autonomous
22
Q
Anxious Attachment
A
- seek contact after separation but not comforted by it.
- clingy and angry child who’s likely to throw tantrum
- derives from intermittently available parents and enmeshed family relationships
- as adult tends to be pre-occupied
23
Q
Avoidant Attachment
A
- avoid contact after separation and sulk
- as adult are dismissing, distant and disengaged family relationships
24
Q
Disorganised attachment
A
- clingy, avoidant and disorganised as child
- as adult fearful with tendency to experience approach/avoid conflicts
- derives from abusive/absent parenting, disorganised and disorienting family style
- most likely to have borderline pd
25
Contextual predisposing factors: Stimulation
- lack of sensorimotor & intellectual stimulation contributes to low cognitive functioning;
- presence of toys in the house & number of opportunities parents use to stimulate kids associated with current intellectual level
26
Contextual predisposing factors: parenting styles
- Authoritarian, authoritative, permissive or neglecting style
27
Contextual predisposing factors: exposure to family problems
- parental psychiatric & medical problems, incl. depression, substance use, criminality, violence
- marital conflict,
- family disorganisation
28
Contextual predisposing factors: stresses
- bereavement
- low socio-economic status
- separations
- institutional upbringing
29
Contextual Maintaining Factors: family system factors
- unintended reinforcement
- insecure attachment
- coercive interaction patterns (parents withdrawing from parenting conduct problems becomes a reinforcement)
- parental over-involvement
- disengagement (negative effect on language development in young children and maintains conduct problems)
- inconsistent discipline
- confused communication patterns
- triangulation (inappropriate cross-generational alliances)
- father absence (associated with conduct problems in boys)
30
Contextual Maintaining Factors: Parent Factors
- having similar problems as child,
- mental illness,
- poor knowledge of child development,
- poor attachment relationships with own parents
31
Contextual Maintaining Factors: social network factors
- lack of social support
- chronic life stressors
- unsuitable school placement
- deviant peer group membership
- community problems (gang violence, social exclusion)
32
Personal Protective Factors: Biological
good personal health
33
Personal Protective Factors: psychological
- high IQ & high self-esteem;
- mature defences, e.g. self observation & assertion, humour & sublimation;
- easy temperament
- Functional coping mechanisms
34
Personal Protective Factors: treatment system
- family acceptance of problem and formulation
- commitment to treatment
- good working relationship between family and support systems
35
Personal Protective Factors: family system
- secure attachments
- clear communication styles
- flexibility around roles and functions
36
Personal Protective Factors: social network factors
- availability of resources
| - appropriate school placement
37
Intellectual Disability
disorder consisting in functional limitations in cognitive and adaptive skills in specific environments (home, school, community), thus necessitating support in order to live meaningfully within the contexts; assessment with standardized IQ & adaptive behaviour scales = diagnostic requirement
38
Key interventions for families with ID individuals
1. psycho-education (providing unambiguous info about diagnosis, helping family work through shock and denial)
2. Organising appropriate supports and services (appropriate school placements, accessing state resources)
3. life-skills training (helping parents to coach their kids' life skills development in an appropriate way)
4. challenging behaviour ( eg aggression identify and assess contextual factors that predispose, precipitate and maintain these)
5. family grief counselling (required at critical lifecycle transitions such as receiving diagnosis, changing schools, onset of puberty, death of parents)
39
Suicide
- Increase from childhood to adolescence; late adolescence 2to5 X more males than females complete suicide, which may be linked to histories of conduct problems:
- Males who complete suicide typically impulsive, aggressive risk-takers whose self harming involves shooting & hanging
- more suicidal ideation and attempts in females, often linked to mood & anxiety problems
40
Suicidal intention
advanced planning, including precautions against discovery; choice of potentially lethal method; have not sought help for any suicide attempt and complete final act (e.g. suicide note, giving away possessions)
41
Suicidal ideation
thoughts of suicide or non-lethal self-harm reported; no clear plan of killing self; absence of intention, acceptance of suicide contract = NB personal protective factors
42
Suicide: risk assessment
- Method NB when doing risk assessment, as some more lethal, e.g. poisoning or gun; check availability of the method-of-choice as this will tell you about likelihood of completion
- Also NB to keep in mind that suicides can be accidental, e.g. where teen misunderstands lethality of some method. So para-suicide is a risk factor for completed suicide
- Attempts often precipitated by interpersonal conflict with intimate partner or parent
43
Commonly reported motives for suicide
- Escape from unbearable pain of loss, so death = relief
- Aggressive act expressing revenge for abandonment (real & perceived)
- Self-punishment for not living up to standards (own or parents)
- Suicide as a way of preserving family
- Para-suicide = attention
44
Suicide risk factors
- Personality traits: perfectionism, impulsivity, hostility, aggression and rigidity
- Psychopathology-related: substance abuse, conduct disorder, anti-social & borderline PD; Depression strong association with suicide, esp. MDE
- Historical: previous attempts, early life loss of parent, previous psychiatric or legal problems
- Family: family history of substance abuse, violence, depression and suicide attempts
- Demographic factors: e.g. gender; social class,
