Developmental Psych/Child Flashcards
Causes of psych disorders
- Genetics: Family Hx of MH issues
- Environmental factors: stressors, family/social life, abuse, pregnancy (prenatal care, mother’s mental health)
- Medical Treatments/Medical Problems
- Unknown
Still Face Experiment
- Shows infants can engage in social interaction
- 1 year old baby and mom “talking”, pointing, engaging, working to coordinate their emotions
- Mother doesn’t respond, gives still face for 2 minutes, baby uses all skills to try and get her attention and get her to engage. Baby cries and becomes distressed when mom doesn’t respond
Piaget’s Cognitive Development Model outline
Sensorimotor (0-2)
Pre-operational (2-7)
Concrete Operational (7-11)
Formal Operational (11-15)
Sensorimotor Stage of Piaget’s Cognitive Development Model
- Rapid cognitive growth
- Most action is reflexive
- Perception of events are centered on the body
- Objects are an extension of self, extreme egocentrism
- Trial and error learning
- OBJECT PERMANENCE at 8-9 months
Object Permanece definition
- knowing that an object still exists even if it’s hidden
- it requires the ability to form a mental representation (schema) of the object
- Happens at 8-9 mo
Smiling and cooing begins at
2 months
Stranger anxiety and separation anxiety starts at
6-8 months
Transitional Objects
- Objects that help a young child make the emotional transition from dependence to independence from mom (blanket)
- 6-18 months
Rapprochement
- 15 to 24 months
- The child moves away from and the returns to the mother for reassurance
Separation Anxiety
-usually ends around 2 yrs
Object constancy
- 2-3 years
- It takes time, and experience of the reliability of the key people in their world, for them to develop a sense that when Mommy leaves the room, she’s still on the same planet, and will reappear again.
Pre-operational Stage of Piaget’s Cognitive Development Model
-Age 2-7
*increase in pretend play
*still egocentric
-symbolic play and manipulating symbols
-able to form stable concepts as well as magical beliefs
-still not able to perform operations, which are tasks that the child can do mentally, rather than physically
-
2 substages of Pre-operational Stage
- Symbolic function substage: able to understand, represent, remember, and picture objects i their mind without having the object in front of them
- Intuitive thought substage: tend to propose the questions of “why?” and “how come?” This strange is when children want the knowledge of knowing everything
Example of egocentrism
having or regarding the self or the individual as the center of all things
-example of child recalling objects in volcano scene from his own perspective
Magical thinking
- Age 2-7 yrs
- Child’s belief that what he or she wishes or expects can affect what really happens
Examples of Conservation
- picture in slide
- How many coins are there? (spread coins out) Now how many coins are there?
- Which ball has more clay? (roll one ball out) Now which shape has more clay?
Concrete operational Stage of Piaget’s Cognitive Development Model
- age 7-11 years old
- appropriate use of logic
- elimination of egocentrism
- thought process becomes more mature
- they start solving problems in a more logical fashion
- abstract, hypothetical thinking is not yet developed int he child
- conservation
- child understands that death is irreversible around age 7
Formal operational Stage of Piaget’s Cognitive Development Model
- Age 11 to 15
- Abstract thoughts
- Problem solving
Erikson’s Psychosocial Stages
- Trust vs Mistrust (Birth-2)
- Autonomy vs Shame and Doubt (1 1⁄2 - 3)
- Initiative vs Guilt (3-6)
- Industry vs Inferiority (7-11)
- Identity vs Role Confusion (12-18
- Intimacy vs Isolation (18-40)
- Generativity and Stagnation (40-65)
- Integrity vs. Despair (>65)
https://theoriesinpsychologyf10.wikispaces.com/Erikson%27s+Psychosocial+Stages+of+Development
Erikson’s Psychosocial Stages: Trust vs Mistrust
- Birth to 2
- Infant forms trust that others will provide care for basic needs, or lack confidence in others
Erikson’s Psychosocial Stages: Autonomy vs Shame and Doubt
- 1.5 to 3 yrs
- Infant becomes self-sufficient in many activities (walking, toileting, feeding, talking), or they may have doubts about their abilities
Erikson’s Psychosocial Stages: Initiative versus Guilt
- Age 3 to 6
- More assertive and taking more initiative, but may be too forceful, leading to guilt feelings (disapproval from parents if they try to exert too much power)
Erikson’s Psychosocial Stages: Industry versus Inferiority
- Age 7 to 11
- Competency
- children have to cope with new social and academic demands; success leads to competence and failure leads to inferiority
Erikson’s Psychosocial Stages:
Identity versus Role Confusion
- Ages 12-18
- Teens need to develop a sense of self and personality identity; Success leads you to be true to yourself whereas failure leads to role confusion and a weak sense of self
Erikson’s Psychosocial Stages:
Intimacy versus Isolation
- Ages 18-40
- Young adults seek companionship and love with another person or become isolated from others by fearing rejection and disappointment
Erikson’s Psychosocial Stages:
Generativity and Stagnation
- Ages 40-65
- Middle-age adults contribute to the next generation by performing meaning work, creative activities, and/or raising family, or become stagnant and inactive
Erikson’s Psychosocial Stages:
Integrity vs. Despair
- Over 65 years old
- older adults try to make sense of their lives, whether seeing life as a meaningful whole or despairing at goals never reached and questions never answered
Freudian Psychosexual Stages Personality and Iceberg Theory
Id: unconscious urges to obtain pleasure (bottom of iceberg)
Ego: mediates the demands of the id, the superego and reality (tip of iceberg)
Superego: how to behave based on learned morals and values.(middle part of iceberg, half in half out)
Freudian Psychosexual Stages
- Oral Stage (Birth – 1 1⁄2)
- Anal Stage (1 1⁄2 - 3)
- Phallic Stage (3-6)
- Latency (7-11)
- Genital Stage (12-18)
Freudian Psychosexual Stages: Oral Stage
- Birth to 1.5
- the mouth, tongue and gums are the focus of pleasurable sensations in the baby’s body, and feeding is the most stimulating activity
Freudian Psychosexual Stages:
Anal Stage
- 1.5 to 3 years old
- The anus is the focus of the pleasurable sensations in the baby’s body and toilet training is the most important activity
- Comparable to Erikson’s autonomy vs shame and doubt
Freudian Psychosexual Stages:
Phallic Stage
- Age 3 to 6
- The phallus, or penis, is the most important body part and pleasure is derived from genital stimulation
- Oedipal conflict: Boys are proud of their penis, and girls wonder why they don’t have one
- Oedipal complex: a boy is fixated on his mother and competes with his father for maternal attention
- Electra Complex : the attraction of a girl to her father and rivalry with her mother, is sometimes called the Electra complex
Gender identity occurs at
age 3
phallic stage
Freudian Psychosexual Stages:
Latency
- Age 7 to 11
- not a stage but an interlude when sexual needs are quiet and children put their energy into conventional activities like school work and sports
Freudian Psychosexual Stages:
Genital Stage
- Age 12 to 18
- the genitals are the focus of pleasurable sensations, and the young person seeks sexual satisfaction in relationships
Freudian Psychosexual Stages:
Adulthood
- Age 18 and up
- Freud believed that the genital stage lasts throughout adulthood. He also said that the goal of healthy life is “to love and to work well”
Regression
- Defense mechanism in when an individual’s personality reverts to an earlier stage of development, adopting more childish mannerisms.
- This is usually in response to stressful situations
Separation Anxiety Disorder
Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:
1. excessive distress when anticipating or experiencing separation from home
2. excessive worry about losing major attachment figures (harm, injury, death, disaster)
3. excessive worry about experiencing an untoward event
4. reluctance or refusal to go out, away from home, to school,
to work
5. excessive fear/reluctance about being alone or
without major attachment figures at home
6. reluctance or refusal to sleep away from home
7. repeated nightmares about separation
8. repeated complaints of physical symptoms (headaches, stomachaches, N/V) when separation from parents, etc is anticipated
To qualify as Separation Anxiety Disorder must have:
- fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults
- disturbance causes clinically significant distress or impairment of functioning
Attachment Theory
how human beings respond within relationships when hurt, separated from loved ones, or perceiving a threat
- Essentially, attachment depends on the person’s ability to develop basic trust in their caregivers and self
- Secure Attachment, Insecure Attachment, Avoidant Attachment, Resistant/Ambivalent Attachment, Disorganized Attachment
Reactive Attachment Disorder (Criterion A)
A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
- child rarely or minimally seeks comfort when distressed
- child rarely or minimally responds to comfort when distressed
Reactive Attachment Disorder (Criterion B)
A persistent social and emotional disturbance characterized by at least two of the following
- Minimal social and emotional responsiveness to others
- Limited positive affect
- Episodes of unexplained irritability, sadness, or fearfulness seen during nonthreatening interactions with caregivers
Reactive Attachment Disorder (Criterion C)
The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following
- Social neglect or deprivation (lack of having basic emotional needs for comfort, stimulation, and affection met by adults)
- Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care)
- Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios
*Care in this criterion is presumed to be responsible for the disturbed behavior in criterion A (Behavior in A occurs because of lack of care in criterion C)
Age range for Reactive Attachment Disorder
- The disturbance is evident before age 5 years. The child has a developmental age of at least 9 months.
- The criteria are not met for autism spectrum disorder.
Autism Spectrum Disorder is NOT a behavior disorder but a
neurobiological disorder
Causes of ASD
- It’s likely that both genetics and environment play a role
- No link between vaccines and ASD
Refrigerator Mother Theory
Refrigerator mother theory is a widely discarded theory that autism was caused by a lack of maternal warmth. Current research indicates that genetic factors predominate in the cause of autism.
How to diagnose autism
- ADOS: Autism Diagnostic Observation Schedule
- ADI-R: Autism Diagnostic Interview, Revised
- M-CHAT: Modified Checklist for Autism in Toddlers
- CARS: Childhood Autism Rating Scale
Risk Factors for ASD
- Identical twins (other affected 36-95% of the time)
- Non identical twins (other is affected 0-31% of the time)
- Parents who have child with ASD (2-18% next child will have ASD)
- children born to older parents have higher risk
- small % of children born prematurely or with low birth weight have greater risk
- genetic/chromosomal conditions
genetic/chromosomal conditions associated with ASD
about 10% of kids with ASD also have: Down syndrome, fragile X, tuberous sclerosis, and others
Prevalence of ASD
1 in 68 kids
- all racial, ethnic, and socioeconomic groups
- boys>girls
ASD diagnostic criteria (A)-
Persistent deficits in social communication and social interaction across multiple contexts manifested by (or history of):
- Deficits in social-emotional reciprocity (abnormal social approach and failure of normal back-and-forth conversation; reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
- Deficits in nonverbal communicative behaviors used for social interaction, abnormalities in eye contact and body language or deficits in understanding and use of gestures; lack of facial expressions and nonverbal communication.
- Deficits in developing, maintaining, and understanding relationship, difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
ASD Diagnostic Criteria (B)-
Restricted, repetitive patterns of behavior, interests, or activities of at least 2 of the following:
- Stereotype/repetitive motor
movements, use of objects, or speech: insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day). - Highly restricted, fixated interests that are abnormal in intensity or focus
- Hyper- or hyporeactivity to sensory input
Severity levels for ASD
- Level 3 “Requiring very substantial support”
- Level 2 “Requiring substantial support”
- Level 1 “Requiring support”
Treatment for ASD
- NO MEDS
- Therapy: Floortime, ABA (Applied Behavioral Analysis)
- If speech/motor skill delay, speech therapy, occupational therapy, PT
- Early intervention/treatment can lead to better prognosis
Comorbid disorders/symptoms
- Irritability, aggression: FDA approved is risperidone (Risperdal) and aripiprazole (Abilify)
- Anxiety: SSRIs (Prozac, Zoloft)
- ADHD: stimulants/non-stimulants
(Ritalin, Adderall/Strattera)
ADHD
- 4-8% of kids (males are more hyperactive and inattentive)
- 2/3 have comorbid psych disorders (CD/ODD, mood disorders, anxiety, substance disorders)
Treatment for ADHD
Stimulants (lessens substance use not worsens)
-Methylphenidate (Ritalin)
Etiology of ADHD
Genetic Factors Environmental Factors Neurochemical factors Neurophysiological factors Toxins exposures, head trauma, prenatal and perinatal factors
ADHD Structural Imaging
slightly smaller right prefrontal cortex, caudate nucleus, globus pallidus
ADHD functional imaging
- (fMRI, PET, SPECT) suggest lower basal activity in prefrontal cortex and striatum
- areas high sensitive to catecholamine input, NE and DA
DSM-5 diagnostic criteria for ADHD
1) Inattention (6+ of the following: doesn’t listen or makes careless mistakes, can keep attention in activities, doesn’t follow through on instructions/doesn’t finish chores or school work, unorganized, avoids hard tasks, loses things, easily distracted)
2) Hyperactivity and Impulsivity (fidgets, squirms, leaves seat, runs or climbs, loud, “on the go”, talks excessively, blurts out answers, can’t wait their turn, interrupts)
DSM-5 age of onset/time line
Onset by age 12 (DSM-4 onsite age 7)
occurs for >6 months in more than one setting (school, home, church, camp, etc)
ADHD qualities
Family history, young age of onset, sustained clinical course
Bipolar affective disorder qualities
Grandiosity, decreased sleep, elevated mood, family history, episodic clinical course
Shared characteristics of ADHD and Bipolar affective disorder
distractibility, impulsivity, hyperactivity, mood swings, irritability
ADHD treatment
Stimulants (methylphenidate, dextroamphetamine, amphetamine salts)
- MOA: blocks reuptake and increases release of NE and dopamine
- Augmentation of dopamine and adrenergic action throughout the CNS –prefrontal cortex is the target
- Drawbacks/side effects: decreased appetite, weight loss, stunted growth, insomnia, motor/vocal tics, headaches, irritability, hallucinations
Other treatments of ADHD
Non-stimulants
-Atomoxetine (Strattera) variation of tricyclic antidepressant – 5HT
and NE reuptake inhibitor- 65% effective
-Alpha-2 agonists (clonidine, guanfacine), Buproprion hydrochloride (Wellbutrin XL), TCAs
Oppositional Defiant Disorder
- A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four:
1) Angry/Irritable mood (loses temper ofter, touchy/easily annoyed, angry/resentful)
2) Argumentative/Defiant Behavior (argues with authority figures/adults, defies/doesn’t follow rules, deliberately annoys others, blames others for their misbehavior)
3) Vindictiveness (spiteful or vindictive at least 2x in past 6 months)
During Oppositional Defiant Disorder, the disturbance in behavior is associated with
distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning.
-Pts criteria DO NOT meet that for disruptive mood dysregulation disorder
Oppositional Defiant Disorder treatment
- Behavior Modification
- Treating comorbid disorders, such as ADHD, may reduce ODD behaviors
Conduct Disorder
- severe disruptive behavior disorder
- “bad boys” and “bad girls”
- boys>girls
- genetic/environmental factors
- High incidence of ADHD and learning disorders
- 40% develop antisocial personality disorder
Conduct Disorder criteria
- Agression to people and animals (bullies, starts physical fights, uses weapons, physically cruel, stolen, forced sexual activity)
- Destruction of Property (fire setting, etc)
- Deceitfulness or Theft (breaking into someones house, stealing, lies to obtain goods)
- Serious Violations of Rules (out passed curfew, runaway from home overnight at least twice, truant to class)
What adult disorder is associated with CD?
Antisocial personality disorder (conduct disorder as a child is required for a diagnosis of antisocial personality disorder in adults)
CD treatment
Multi-systemic Therapy: intensive, family-focused and community-based treatment program
Enuresis
- Repeated voiding of urine into bed or clothes, whether involuntary or intentional
- at least 2x/week for at least 3 consecutive months
- at least 5 years old
- The behavior is not attributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure disorder)
Enuresis treatment
- Motivational Therapy
- Bell and Pad Alarm
- TCAs: Imipramine/Desipramine
- Antidiuretic: DDAVP (desmopressin)
Encopresis
- Repeated passage of feces into inappropriate places (e.g., clothing, floor)
- At least one/month for at least 3 months
- at least 4 years old
- The behavior is not attributable to the physiological effects of a substance (e.g., laxatives) or another medical condition except through a mechanism involving constipation.
What to specify for Encopresis
- With constipation and overflow incontinence: There is evidence of constipation on physical examination or by history.
- Without constipation and overflow incontinence: There is no evidence of constipation on physical examination or by history.
Disruptive Mood Dysregulation Disorder
- Severe temper outbursts at least 3x/week
- Sad, irritable or angry mood almost every day
- Reaction is bigger than expected
- at least 6 years old
- SYMPTOMS BEGIN BEFORE AGE 10
- s/s present for at least 1 yr
- child has trouble functioning in more that one place
Disruptive Mood Dysregulation Disorder treatment
-Meds to target child’s symptoms
-Irritability/sadness: antidepressant
-Temper outbursts: mood stabilizer or atypical antipsychotic
(Risperdal, Abilify)
