Childhood Disorders Flashcards
1
Q
What are normal childhood behaviors?
A
Disobedience, agression, temper tantrums
2
Q
When do these normal behaviors become an issues?
A
When children enter school, they should be able to control their behaviors. Otherwise they are at risk for problems adjusting, learning, and peer rejection
3
Q
Conduct Disorder
A
Repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.
4
Q
Aggression to People and Animals (CD)
A
- Bullies, threatens, or intimidates others
- Initiates physical fights
- Uses a weapon that can cause serious physical harm to others
- Physically cruel to animals
- Physically cruel to people
- Steals while confronting a victim
- Forces someone into sexually activity
5
Q
Destruction of Property (CD)
A
- Deliberately engages in fire setting with intention of causing serious damage
- Deliberately destroys others’ property
6
Q
Serious Violation of Rules (CD)
A
- Stays out at night despite parental prohibitions, beginning before age 13
- Runs away from home overnight at least 2 times while living in a parental (or surrogate) home, or 1 lengthy running away episode
- Truant from school, beginning before age 13
7
Q
Conduct Disorder Diagnosis
A
3 (or more) criteria symptoms
Criteria present in the past 12 months
At least 1 criterion present in the past 6 months
Clinically significant impairment
Criteria not met for Antisocial Personality Disorder (if over age 18)
8
Q
Subtypes of Conduct Disorder
A
Childhood Onset
- 1 symptom present before age 10
- Male, aggressive, few friends, become antisocial adults
Adolescent Onset
- No symptoms before age 10
- Less aggressive, have friends, unlikely to be antisocial adults
9
Q
Terrie E. Moffitt
A
- Adolescence-Limited and Life Course-Persistent Antisocial behavior
- Antisocial behavior increases almost 10 fold temporarily during adolescence
- Peak at 17
- A small group engage in antisocial behavior at every stage of development
10
Q
Life-Course Persistent
A
Children’s problems interact cumulatively, culminating into a pathological personality
11
Q
Adolescence-Limited
A
A maturity gap encourages teens to mimic antisocial behavior in ways that are normative
12
Q
Studies of Antisocial Behavior
A
- A steep incline in antisocial behaviors between ages 7 and 17
- By age 28, almost 85% of former delinquents stop offending
- One study found that 5% to 6% of offenders are responsible for 50% of known crimes
13
Q
Associated Features of CD
A
- Little empathy
- More aggressive in ambiguous situations
- Misperceive intentions of others as more hostile
- Callous
- Lack of guilt or remorse
- Blame others for misdeeds
- Low self-esteem even though they may present as “tough”
- Early onset of sexual behavior, drinking, smoking, using drugs, and risk taking acts
- Suicidal ideation, attempts, and completions are at a higher rate than expected
- May be associated with lower than average intelligence (especially verbal)
- Learning and communication disorders
- Some studies: lower heart rate and lower skin conductance
- Hard to evaluate remorse (they learn that expressing guilt may reduce or prevent punishment)
14
Q
Predisposing Factors of Conduct Disorder
A
- Parental rejection and neglect
- Difficult infant temperament
- Inconsistent child rearing practices with harsh discipline
- Physical or sexual abuse
- Lack of supervision
- Early institutional living
- Frequent changes of caregivers
- Large family size
- History of maternal smoking during pregnancy
- Peer rejection
- Association with delinquent groups
- Neighborhood exposure to violence
- Familial psychopathology (ASPD, substance dependence)
15
Q
CD Statistics
A
- More common in males
- 1% to 10% of the general population
- Higher in urban settings
- Cultural implications?
- Adaptive? (have to act out to fit in in prison, stealing to eat)
16
Q
CD Trajectory
A
- Lying, shoplifting, physical fighting
- Burglary
- Rape, theft
17
Q
Edmund Kemper (Coed Killer)
A
- IQ 136
- Sadistic tendencies
- Tortured animals at age 10
- Locked in basement
- Sent to live with grandparents at age 16
- Paranoid, grandiose delusions
- Shot grandparents
- Sent back to mom, went on serial killer rampage and killed mom
18
Q
Aggressive Children and cues
A
- They take in less cues
- Are less likely to seek information in ambiguous situations
- Tend to selectively attend to more provocative and aggressive cues
19
Q
Aggressive Girls
A
Predominant Behaviors
- Lying
- Shoplifting
- Running away
- Truant
- Using drugs
- Engaging in prostitution
20
Q
Gender Differences
A
- Girls have lower levels of physical aggression and crime
- Show more status violations (e.g. running away) and conflicts with authority
- Harm is caused through damage to relationships or social status within a group rather than physical violence
21
Q
CD Etiology
A
- Influenced by both genetic and environment factors
- The risk for conduct disorder is increased with a sibling who is conduct disordered
- More common in children of parents who have ASPD, Alcohol Dependence, Schizophrenia, AD/HD, or Conduct Disorder
22
Q
CD Developmental Factors
A
- Aggressive children are unpopular and excluded from peer groups
- Aggression as the more important reason a child is rejected by peers
- Perform below average in school achievement
- Low achievement, low vocabulary, and poor verbal reasoning have been found to correlate significantly with delinquency
- Their social and interpersonal skills are below average for their age
- Stealing - one of the more robust risk factors for delinquency
23
Q
Posttraumatic Stress Disorder (PTSD)
A
- A severe psychological reaction, lasting at least one month and involving intense fear, helplessness, or horror, to intensely traumatic events
- An intense re-experiencing of the traumatic event through recollection or nightmares
- Due to war, natural disaster, civilian catastrophe, or personal trauma
- Acute Stress Disorder (before one month)
24
Q
PTSD in Childhood
A
Potential traumatic events - Violence (i.e. physical abuse) - Witnessing violence - Divorce - Psychological abuse - Bitten by a dog Specific traumatic events that result from human intent (physical abuse, sexual abuse, threats) are more likely to cause PTSD versus accidents or natural disasters
25
How PTSD appears in youth
- Distressing dreams
- Generalized nightmares of monsters
- Rescuing others
- Threats to self or others
- Reliving the trauma may occur through repetitive play (reenacting a car accident with toys)
- Stomach and headaches
- The feeling that life will be too short to include becoming an adult
- Omen formation - the belief in an ability to foresee untoward events
26
PTSD & risk factors
Not everyone who is exposed to a traumatic event will develop PTSD
Factors that increase the likelihood of being exposed to trauma:
- Being male
- Having less than a college education
- Having conduct problems in childhood
- A family history of psychiatric disorder
- Scoring high on a measure of extraversion and neuroticisms (easily upset)
27
Protective Factors and PTSD
Breslau and Colleagues
- Collected IQ data from 6 year old children
- When they reached age 17, evaluated for trauma and PTSD
- Above 115 IQ were less likely to have experienced a traumatic event by 17
- If they had been exposed to trauma they were less likely to develop PTSD
28
Childhood Depression
- Withdrawal
- Crying
- Avoidance of eye contact
- Physical complaints
- Poor appetite
- Aggression
- Irritability (substituted for depressed mood in adults)
- In extreme cases - suicide
29
Etiology in Childhood Depression
- Association between parental depression and behavioral and mood problems in children
- Prenatal exposure to alcohol
- Exposure to stressful events
- Exposure to negative parental behavior
- Childhood depression more common in divorced families
30
Bipolar in Children and Adolescents
- 1% of general population
- High co-morbid diagnosis of AD/HD
- Is bipolar in children the new AD/HD?
31
Anxiety Disorders in Childhood
- Often under-recognized
- As common and debilitating as Disruptive Behavior Disorders
- All can apply to adults (except Separation Anxiety Disorder)
- Symptoms tend to be less cognitive and more physical
32
Social Phobia
- Fear of social or performance situations in which embarrassment might occur
- Onset usually in adolescence
- Most common fear is public speaking
- Paralyzing fear of strangers
- Withdrawn, mute, tantrums
- Stranger fear is normal at 8 months old
- Prevalence is 2-13% of children/adolescents
- Well-adjusted at home, but academic and social impairments at school
33
Generalized Anxiety Disorder
- Anticipatory anxiety about performance situations
- Doubt own capabilities
- Constantly seek approval
- Parental love conditional on "good" behavior
34
Separation Anxiety Disorder
- Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached
- Prevalence: 2 to 5%
- Course: appears before age 18, lasts several years, intensity fluctuates
35
Normal separation anxiety
- Peaks around 12 months old
| - Disappears and then reappears intensely following life stressor
36
ADHD Inattention Symptoms
- Poor attention to detail or careless mistakes
- Difficulty sustaining attention in tasks or play
- Does not seem to listen when spoken to directly
- Does not follow through on instructions and fails to finish schoolwork, chores, or duties
- Difficulty organizing tasks and activities
- Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
- Loses things necessary for tasks or activities
- Easily distracted by extraneous stimiuli
- Forgetful in daily activities
37
ADHD Hyperactivity-Impulsivity Symptoms
- Fidgets with hands or feet, or squirms in seat
- Leaves seat when remaining seated is expected
- Inappropriately runs about or climbs excessively
- Difficulty playing or engaging in leisure activities quietly
- "On the go" or acts as if "driven by a motor"
- Talks excessively
- Blurts out answers before questions have been completed
- Difficulty awaiting turn
- Interrupts or intrudes on others
38
ADHD Diagnosis
- 6 (or more) symptoms in either category (inattention & hyperactivity-impulsivity)
- Symptoms persist for at least 6 months
- Maladaptive/inconsistent with developmental level
- Some symptoms present before age 7
- Impairment in 2 (or more) settings
- Clear evidence of clinically significant impairment in social, academic, or occupational functioning
39
Types of ADHD
- Predominantly Inattentive
- Predominantly Hyperactive-Impulsive
- Combined (most common, worst prognosis)
40
ADHD Stats
- 3 to 7% prevalence in school-aged children
- More common in boys (9.5%) than in girls (5.9%)
- Diagnosis of ADHD increased an average of 3% per year from 1997 to 2006
- Significantly higher rates among non-Hispanic, primarily English-speaking, and insured children
41
ADHD Correlates
- Severe functional impairments
- Academic performance
- Adaptive functioning
- Social relationships
- Following rules
- Health (e.g. major injuries)
- Sleep patterns
- 80% of children show symptoms into adolescence
- 42% show symptoms as adults
42
ADHD and Forensics
- Estimated to affect 1/3 of prison population
- Main problem - missed environmental cues, failure to plan effectively/considering alternative, impulsivity, and lack of self control
- Self Medication - cocaine, cannabis, nicotine, and alcohol
- A risk factor for criminal behavior
43
CD & ADHD
85% of children with conduct disorder also meet the criteria for ADHD
44
ADHD Prognosis
- Many hyperactive children retain ADHD into adulthood
- Many have substance abuse problems in teens
- In one study, 34.6% of treatment seeking cocaine addicts were ADHD
45
Oppositional Defiant Disorder (ODD)
- Pattern of negativistic, hostile, and defiant behavior
- Lasting at least 6 months
- 4 (or more symptoms present)
46
ODD Symptoms
- Loses temper
- Argues with adults
- Actively defies or refuses to comply with adults' requests or rules
- Deliberately annoys people
- Blames others for mistakes/misbehavior
- Touchy or easily annoyed by others
- Angry and resentful
- Spiteful or vindictive
47
ODD Prevalence and Risk Factors
- Lifetime prevalence: 11.2% for boys, 9.2% for girls
- Risk factors
- Family discord
- Socioeconomic disadvantage
- Antisocial behavior in parents
- Maternal depression (one study)
48
ODD Associate Factors
- More prevalent in males who:
- Have problematic temperaments (high reactivity, difficulty being soothed) and high motor activity
- Disrupted child care or inconsistent and neglectful parents
- During school years they may also have:
- Low or inflated self-esteem
- Mood lability
- Low frustration tolerance
- Swearing
- Precocious use of alcohol, tobacco, or illicit drugs
49
Enuresis
- Repeating voiding of urine into bed or clothes
- Voluntary or intentional
- Clinically significant
- 2 times per week for at least 3 consecutive months
- Distress/impairment
- At least 5 years old
- Behavior not due to substance or general medical condition
50
Subtypes of Enuresis
- Nocturnal Only
- During nighttime sleep only
- Most common
- Diurnal Only
- During waking hours
- More common in females
- Uncommon after age 9
- Usually in early afternoon on a school day
51
"Triad of sociopathy"
- Bedwetting (impulse control)
- Cruelty to animals
- Fire setting
52
Encopresis
- Repeated passage of feces into inappropriate places
- Whether involuntary or intentional
- At least once per month for at least 3 months
- At least 4 years old
- Behavior not due to substance or general medical condition
53
Insomnia
- Difficulties falling asleep or staying asleep
| - Usually stress - starting school
54
Nightmares
- No particular physiological arousal
| - 10 to 50% of 3 to 5 year olds have nightmares enough to concern their parents
55
Sleep Terror Disorder
- Intense physiological arousal (sweating, hyperventilation, racing heart)
- 1 to 6% of children
56
Sleepwalking Disorder
- Repeated episodes of rising from bed during sleep and walking about
- Usually during first few hours of sleep
- While sleep walking
- Blank, staring face
- Unresponsive to communication
- Only awakened with great difficulty
- Amnesia for sleepwalking episode
- No impairments in mental activity or behavior after awakening from sleepwalking
- 1% of adults sleepwalk - perform complex behaviors (even murder)
57
3 Major Areas of Learning Disorders
- Reading
- Writing
- Mathematics
58
Reading disorder (dyslexia)
- Read slowly and with poor comprehension
| - Drop, substitute, or distort words
59
Disorder of written expression
- Poor paragraph organization
- Faulty spelling, grammar, and punctuation
- Illegible handwriting
60
Mathematics Disorder (Dyscalculia)
- Failure to understand concepts
- Failure to recognize symbols
- Failure to remember operations
61
Learning Disorders
- A statistically significant difference between IQ and achievement
- 2 to 10% of population
- 5% of students in public school
- Demoralization, low self-esteem, and deficits in social skills may be associated
- 40% school drop out rate for children and adolescents
- 10-15% who have CD, ODD, AD/HD, MDD, or Dysthymia also have a learning disorder
62
Communication Disorders
- Delayed speech:
- Problems with articulation
- Difficulties with expressive language
- Delays in receptive language
- By 1 - a few words
- By 18 to 24 months - 2 to 3 word sentences
- Problems may = deafness, autism, mental retardation, or something in the environment
- Stuttering: the interruption of fluent speech through blocked, prolonged, or repeated words, syllables, or sounds
63
Theory and Therapy: Cognitive Perspective
- Negative cognitions in children
| - Changing children's cognitions
64
Theory and Therapy: Behavioral Perspective
- Inappropriate learning
- Inadequate learning
- Need to relearn
65
Theory and Therapy: Interpersonal Perspective
- Family systems - family is a miniature social system (e.g. problems with mom and dad)
- Family psychopathology
- Family therapy
66
Theory and Therapy: Sociocultural Perspective
- Cultural patterns and norms shape behavior
67
Theory and Therapy: Neuroscience Perspective
- Biogenic bases for childhood disorders
| - Drug therapy: psychopharmacology
68
Theory and Therapy: Psychodynamic Perspective
- Play therapy: talk about issues while playing
69
Intellectually Deficient
Criteria:
- Significantly sub-average general intellectual functioning, determined by standardized intelligence tests
- Significant limitations in adaptive functioning - coping with life's demands and independent living
- Onset before 18 years of age
- 1% of the population (DSM-5)
70
Potential Signs of ID
- have trouble speaking
- find it hard to remember things
- have trouble understanding social rules
- have trouble discerning cause and effect
- have trouble solving problems
- have trouble thinking logically
- persistence of infantile behavior
71
Adaptive Functioning (ID)
Must show limitations in at least 2 of the following adaptive skill areas:
- Communication
- Self-Care
- Home Living
- Social/interpersonal skills
- Use of Community Resources
- Self-Direction
- Functional Academic Skills
- Work
- Leisure
- Health
- Safety
72
Mildly ID
- 85% of those diagnosed
- IQ of 50-55 to 70
- Can function independently in most areas
- As a child, they develop more slowly and need help longer with self-care (eating, dressing, and toilet training)
- In adolescence, they can function independently in most areas of life
- Can speak fluently, read easy material, and do simply arithmetic
- May need an adviser (particularly with money)
- Most hold a job, have friends
- Some marry and have children
73
Moderate ID
- 10% of diagnosed
- IQ of 35-40 to 50-55
- As children - can feed themselves with a cup and spoon, cooperate with dressing, begin toilet training, use some words and recognize shapes
- Adolescence - have good self-care skills, can carry on simple conversations, read a few words, and do simple tasks
- Many live in community-based group homes or with families
74
Severely ID
- 3 to 4% of diagnosed
- IQ of 20-25 to 35-40 (considerable supervision and some self-care)
- Can learn some self-care skills
- With proper training can perform jobs in a sheltered workshop or daytime activity center
- They require considerable supervision
- They can understand language but many have trouble speaking
- Their reading and math skills are not sufficient for independent living
75
Profoundly ID
- 1 to 2% of diagnosed
- IQ of 20-25 or below
- Can carry-out some self-care activities
- Require extensive supervision and help
- Language is a severe problem
- May understand simple communications but have little or no ability to speak
- Most remain institutionalized
76
Fragile X Syndrome
- The X chromosome shows a weak spot, where it appears to be bent or broken
- X chromosome determines sex
- Large, prominent ears, elongated face
- Most common cause of Autistic like behaviors
77
Down Syndrome
- Trisomy 21 - an extra chromosome in pair 21
| - Slanting eyes, flat nose, small round head, small mouth, protruding tongue
78
Amniocentesis
- Check for developmental disorders
| - Risk piercing amniotic fluid and introducing something negative (teratogens)
79
Prenatal Environmental Factors
- Drugs and other Teratogens
- Exposure to damaging chemicals
- Fetal Alcohol Syndrome (FAS) - short eye slits and nose, narrow upper lip, IQ between 40 and 80
- Malnutrition
- Severe lack of one or more biological building blocks
80
Postnatal Environmental Factors
- Toxins
- Physical trauma
- The effects of deprivation .- STRESS
81
Early Infantile Autism
- The inability to relate to anyone outside of oneself
| - New Jersey - 2007 study, highest in the country
82
Autism
- Qualitative impairment in social interactions
- Qualitative impairment in communication
- Restricted and stereotyped patterns of behavior
- Autism affects information processing in the brain by altering how nerve cells and their synapses connect and organize
83
Symptoms of Autism
- Social Isolation
- Intellectual Deficient
- Language Deficits - They cannot engage reciprocally in conversation (give-and-take)
- Echolalia - repetition of spoken words
- Stereotyped behavior (stereotypy) - repetitive or ritualistic movement, posture, or utterance
- e.g. body rocking, or complex, such as self-caressing, crossing and uncrossing of legs, and marching in place
84
Theories of Autism
The Biological Perspective
- Genetic research
- Chromosome studies
- Biochemical studies
- Congenital disorders and birth complications
- Neurological research
- No clear etiology
- Vaccinations are not the cause
85
Anorexia Nervosa
- Refusal to maintain normal body weight (85% less than normal for age and height)
- Intense fear of obesity, even though underweight
- Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
- Amenorrhea, in post-menarcheal females
86
Amenorrhea
The absence of at least 3 consecutive menstrual cycles
87
Anorexia Stats
85-90% female
88
Types of Anorexia
Binge Eating/Purge Type
- Regular binge eating or purging behavior
- Self-induced vomiting, misuse of laxatives, diuretics, or enemas
Restricting Type
- Refuse to eat
- No regular binge eating or purging behavior
89
Bulimia Nervosa
- Recurrent episodes of binge eating
- Eating large amount of food in discrete time period (2 hours)
- A sense of lack of control over eating
- Recurrent inappropriate compensatory behavior in order to prevent weight gain
- Self-induced vomiting (90%)
- Misuse of laxatives, diuretics, or enemas
- Fasting or excessive exercise
- Both occur at least 2 times per week for 3 months
- Self-evaluation unduly influenced by body shape/weight
90
Types of Bulimia
Purging Type
- Regular self-induced vomiting or misuse or laxatives, diuretics, or enema
Non-Purging Type
- Other inappropriate compensatory behaviors
- Fasting or excessive exercise
91
Childhood Obesity
- Often results in low self-esteem
- 15 percent of children and adolescents are obese
- Over 50% of the population
- Who is to blame?
- Culture
- Fashion
- Advertising
- Parents
