Developmental Psychopathology & Interviewing Flashcards
What proportion of children and adolescents exp sig mental illness?
20%
What proportion od adult mental disorders cna be traced to onset in youth?
50%
What are some of main complicating factors when diagnosing child psychopathology?
- sx presentation in youth is rarely neat (comborbidity is the norm)
- within group htereogeneity (e.g. two kids, even sibs, with ADHD can look completely different)
- can rarely trace the cause of disorder to a signle factor
List some common determinants of child psychopathology
genes temperament attachment problems with goodness of fit social cog deficits social learnin deficits emo reg difficulties impulse control response inhibition martial discord effects of poverty exposure to trauma crime or illness etc.
How long is the typical tantrum (for a typically developing child)?
20 mins;
if there’s no immediate risk of physical harm, ignoe ignore ignore
parents reaction moderates the duration and intensity of the tantrum
Short list of biological risk factors
age of the mother poor parental (maternal) nurtrition maternaluse of etoh maternal use of tobacco use of other drugs prenatl and postnatal illness pregnancy or birth complications genetics LBW (this is a biggie; most of hte above place fetus at risk for LBW)
In general, why is maternal age important to know?
B/c with increased age comes increased risk for complicaton
What does Down’s have to do with maternal age?
higher age, increased risk
Down’s = trisomy 21
By age, what proportion of births affected by Downs’?
under 30 = 1 in 1500
40 - 44 = 1 in 130
45 and over = 1 in 64
HUGE jumps in risk
In US, what is considered to be “advacned maternal age?”
35 and older
increased risk for a number of things, e.g. down’s, placenta previa, and LBW (this is the biggie), hypertension, gestational diabetes, and thir trimester bleeding (effects blood development of fetus)
Maternal age, relation to indidence rtes of preg and birth complications
20 - 29 = approx 10%
35 - 39 = approx 20%
risk doubles after 35
When assessing biological risk factors, what are some key questions to ask?
Was your preg remarkable in anyway?
Complications? Major Concerns?
How far along were you when you found out you were pregnant? surprise or planned?
APGAR scores?
Folic acid during preg? prior to preg?
Under the care of a doctor?
Health habits during pregnancy? Etoh? Tobacco or other drugs? Nutrition?
Summarize recent research re: age of fathers?
recent research (Nature, 2012) links advacned paternal age with increased risk for Autism spectrum and other developmental disorders
Early findings; doesn’t prove older fathers more likely to pass on bad genes
basically, the study shows that gene mutations accrue overtime; bad genes put the kid at risk; when interacts with environmental factors
why is maternal nutrition important to know about?
poor maternal nutrion related to wide range of developmental delays and physical complications
How much folic acid should someone take?
approx 400 mg (the does available in most OTC vitamin supplements)
important for preventing NTD’s
MUST begin before pregnancy
relation between folic acid and rates of spina bifida?
research show that takinf standar 400 mg does of folic acid reducares rates of SB by 50%
How much etoh is safe during pregnancy? how much tobacco
there’s not safe amount according to AAP and CDC, and American Preg Associ same for tobacco
Will a little bit of etoh cause FAS?
No, FAS is assocaite with heavy and binge drinking during preg
But, FAE is possbile
Among heanvy drinker moms, what are the chances of FAS?
over 40%
Boradly, what is FAS
syndrome charactersized by a distinct pattern of facial malformations and developmental delays, perceptual-motor deficits, attention deficits, exec fx deficits (planning, problem solving, response inhibition, etc) and activity level problems (temp factor)
the cog, motor, language, and activty deficits een more prououned that phy abnormalities
Re: to FAS and etoh consupmtion what do you wanna ask in your interview?
Did you consume etoh during preg? did you smoke tobacco? how much, on avg, did you drink during preg?
dx FAS
epicanthal folds microcephaly low nasal bridge small chin thin upper lip indistinct philtrum flatened midface low set ears minor ear abnormalisities short palpebral fissures
Tobacco use during preg can result in
premature birth LBW decreased placental blood flow various developmental delays some research suggests, higher risk of cancer and CD, increased risk for ADHD
Effects of other drug use
wide ranging (e.g. attention, emo reg, physcial development; again anything that restricts sixe of fetus is bad)
usually, when maternal drug use is associated with disrupted early child-parent interactions
What percetnage of nerborns are exposed to cocaine
1-2%
Potential effects on fetus from cocaine use during preg?
Spontaneous Abortion Prematurity and Low Birth Weight Microcephaly Fetal Growth Retardation Placental Abruption - A dangerous birth complication in which the placenta separates from the uterus prematurely. Lower IQ Increased rates of leanring, emotional and behavioral disorders SIDS
SIDS rates and cocaine exposed newborns
15%; 30 times that seen in the general population
Marijuana?
Mixed findings; again, anything that resticts blood is bad b/c can result in LBW; neurological effects are liekly; THC crosses the plaental barrier and corsses the blood brain barrier inthe fetus
common pre- or postnatal illnesses or injuries
congential rubella
head injuries
high fevers
strep infections (PANDAS)
congential rubella is associate with
deafness
heart problems
cleft palate
MR
Why are high fevers bad? what’s high?
high varies by individuals, look at patterns over time for a single person
fevers can –> seizure
children under 1, very common to have on seiure that doesn’t repliacte
however, high fever –> siezure –> seizures beget more seizures –> epileptic disorder
PANDAS?
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptoccoal Infentions
OCD-like disorder in children
How can you assess genetic risk for psych disorders?
Ask about family history, not in clinical terms, but with things like:
Anyone worry a lot? Paticularly irrituable? probelms with the law? See things other dont? etc. etc.
How do you assess temperament
Ask questions like: What were they like as a baby? When you picked them up, did they arch toward or away from you? COuld oly one person hold them? How did you soothe your child? Sleep patterns?
These questions map on later categoires of bipolar d/o
what proportion of kids has some kinds of clinically signifcant difficulty?
1 in 5
What proportion of kids has a dx’able disorder?
1 in 10
What are the projections for childhood psych disorders by 2020?
will increase by 50% internationally
will in among the 5 most common causes of morbidity, mortality, and disability worldwide
generally speaking, what do we knoe about gender and rates of childhood psych disorder
gender differences are often found
boys have difficulty eraler in life
girls difficulties usually pop up later in life
boys are more often externlizers
girls are more often itnernalizers
girls are underrap in externalizing studies, and in research in general
generder usually accout for a small rpoprotion of the variance in studies
differences disappear in nonreferred populations; differens most prounounced in referred samples
when is it normal? enuresis
3 years and 8 years
when is it normal? negativsim
2 years and 7 years
when is it normal? separation anxiety
8-24 months and 5 years
when is it normal? in ability to complete tasks
3 years and 10 years
ADHD and perferred vs. nonperferred tasks
assess ability to complete nonperferred tasks; this is much more indicative od sx’s than performance on perferred tasks
exmples of dimiensional mesaures of childhod psychopathology?
BASC, CBCL, the Connors
What does youngstrom (2007) have to say about informant discrepancy?
An early meta-analysis (Achenbach, McConaughy, & Howell, 1987) found:
2 parents tended to agree with each other about a child’s behavior problems (r = .60)
Parents and teachers agreed only minimally (r = .26) on average
Youths only agreed (r = .20) minimally with parents or teachers
Even with the most reliable and widely used behavior rating checklists, cross-informant agreement typically ranges in the range of r = .3-.4 (Achenbach, 1991).
These r values are still LOW
Common findings regarding informant discrepancy
People generally agree more on externalizing than internalizing disorders
Although Seiffge-Krenke & Kollmar, 1998 reported the opposite in their German sample of adolescents
People generally agree for younger rather than older (especially adolescent samples)
Inconclusive for child gender and informant discrepancies
Parents generally agree for chronically ill children rather than healthy controls
Although parents seem to under report capabilities and over patholagize with chronically ill children
Why??
Most studies have found that agreement is lower, or discrepancies are greater, among informants’ ratings of African American children compared with informants’ ratings of European American children.
However, a meta-analysis that focused specifically on mother–father agreement did not find a relation between informant agreement and ethnicity
Parents and teachers agree as often as they disagree
What does youngstrom (2007) have to say about informant discrepancy?
An early meta-analysis (Achenbach, McConaughy, & Howell, 1987) found:
2 parents tended to agree with each other about a child’s behavior problems (r = .60)
Parents and teachers agreed only minimally (r = .26) on average
Youths only agreed (r = .20) minimally with parents or teachers
Even with the most reliable and widely used behavior rating checklists, cross-informant agreement typically ranges in the range of r = .3-.4 (Achenbach, 1991).
These r values are still LOW
Common findings regarding informant discrepancy
People generally agree more on externalizing than internalizing disorders
Although Seiffge-Krenke & Kollmar, 1998 reported the opposite in their German sample of adolescents
People generally agree for younger rather than older (especially adolescent samples)
Inconclusive for child gender and informant discrepancies
Parents generally agree for chronically ill children rather than healthy controls
Although parents seem to under report capabilities and over patholagize with chronically ill children
Why??
Most studies have found that agreement is lower, or discrepancies are greater, among informants’ ratings of African American children compared with informants’ ratings of European American children.
However, a meta-analysis that focused specifically on mother–father agreement did not find a relation between informant agreement and ethnicity
Parents and teachers agree as often as they disagree
