Early Childhood Flashcards
Elimination disorder
Inappropriate elimination of urine of faeces
There are 2 types:
Enuresis (urine)
Encopresis (faeces)
Enuresis
Criteria (DSM-V)
A. Repeated voiding of urine into bed or clothes, whether involuntary or intentional.
B. Clinically significant as manifested by either a frequency of at least twice a week for at least 3 months or presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.
If it doesn’t impact life, don’t technically meet criteria for the disorder
D. Older than 5
E. Not attributed to medicine or substance
Specify whether; Nocturnal only (at night), Diurnal only (during the day), Nocturnal and diurnal (both night and daytime).
Causes of Enuresis
Genetic
ENUR1 genes Chromosome 13
ENUR2 genes Chromosome 13
If both parents bed wetter – child 77% chance
If one parent bed wetter – child 44% chance
If neither bed wetter – child 15% chance
Clear evidence of genetic problem -> therefore 5-year cut-off doesn’t match genetics
psychological
delay in maturation of the mechanism for bladder control
Treatments for Enuresis
1) Rule our organic causes
2) tricyclic antidepressants
3) Enuresis alarms
4) Fluid restriction
5) Positive reward charts
6) Psychotherapy
7) Scheduled wakenings
Encopresis
Fecal soiling in children defined as loss of stool or liquid, at innapropriate times or places.
Needs to happen at least once a month for 3 months
Older than 4 years
Not caused by medical conditions
IF IT’S MEDICAL: it’s called fecal incontenance
PRIMARY: Never sucessfully controlled stools
SECONDARY: Was fine for 6 months, then started having episodes
*Check if they’ve ever been toilet trained
Causes of encopresis
Sometimes biological, but often psychological
Again, change could be affecting secondary encopresis
Fecal Retention
may be when bowel movement is painful so the child avoids it (if they are passing large stools, or using body posture to restrict passing of stools) THIS CAUSES RECTAL DAMMING and nerve damage
Affects 1.5% of children
Night terrors
Sudden waking during slow-wave sleep, with persistent fear or terror, screaming, sweating, confusion and increased heart rate
characterised by sudden waking from slow-wave sleep with persistent fear or terror, screaming, sweating, confusion, and increased heart rate.
usually do not report dreams or nightmares but might have a vague sense of frightening images.
Occurs during stage 3 or 4 of sleep.
Different from nightmares which happen during REM sleep and are remembered.
have benign implications in childhood
most children will outgrow it
often reflect psychopathology or significant stress in adolescents and adults
Organic disorders in the elderly
Night terror interventions
Wake them up 30 minutes before they usually have them
Make sure they’re getting enough sleep
Try and reduce stress
Reactive attachment disorder
Reactive attachment disorder starts in the first 5 years of life and is characterized by persistent abnormalities in the childs pattern of social relationships which are associated with emotional disturbance and are reactive to changes in environmental circumstances. Simple biology dictates that parents and children bond.
Attachment
Attachment is the deep and enduring connection established between a child and caregiver in the first years of life. A failure to develop this is believed to affect future relationships.
DSM Reactive attachment disorder
Consistent pattern of inhibited, emotionally withdrawn behaviour towards adult caregivers, manifested by both:
The child rarely or minimally seeks comfort when distressed
The child rarely or minimally responds to comfort when distressed
They don’t actually have a belief that ‘if I’m upset you’re going to be able to do anything about it’. If you rule out Autism spectrum disorder, it usually comes back to the parents and how they’ve taught them when they’re distressed. In adults exhibits as conduct disorder or antisocial personality disorder.
A persistent social and emotional disturbance characterised by at least 2 of the following:
Minimal social and emotional responsiveness to others
Limited positive affect
Episodes of unexplained irritability, sadness or fearfulness that are evident even during nonthreatening interactions with adults
The child has experienced a pattern of extremes or insufficient care evidenced by at least 1 of the following.
Social neglect or deprivation
Repeated changes of primary caregivers that limit opportunities to form stable attachment
Rearing in unusual settings that severely limit opportunities to form selective attachment
There is a presumption that the carer is criterion C is responsible for the disturbance
Child does not meet criteria for autism
Evident before 5 years old
The child has a developmental age of at least 9 months
Causes of attachment disorder
Abuse and/or neglect
Ineffective and insensitive care
Depression: unipolar, bipolar, postpartum
Severe and/or chronic psychological disturbances: biological and/or emotional
Teenage parenting
Substance abuse
Intergenerational attachment difficulties: unresolved family-of-origin issues, history of separation, loss, maltreatment
Prolonged absence: prison, hospital, desertion
CHILD CONTRIBUTIONS
Difficult temperament: lack of “fit” with parents or caregivers
Premature birth
Medical conditions: unrelieved pain (e.g. inner ear), colicky
Hospitalizations: separation and loss
Congenital and/or biological problems: neurological impairment, fetal alcohol syndrome, in utero frug exposure, physical handicaps
Genetic factors: family history of mental illness, depression, aggression, criminality, substance abuse, antisocial personality
ENVIRONMENTAL CONTRIBUTION
Poverty
Violence: victim and/or witness
Lack of support: absent father and extended kin, isolation, lack of services
Multiple out-of-home placements: moves in foster care system, multiple caregivers
High stress: marital conflict, family disorganization and chaos, violent community
Good attachment
Self esteem
Independence and autonomy
Resilience in the face of adversity
Ability to manage impulses and feelings
Long-term friendships
Relationships with parents, caregivers and other authority figures
Prosocial coping skills
Trust, intimacy and affection
Positive and hopeful belief systems about self, family and society
Empathy, compassion and conscience
Behavioural performance and academic success in school
Promote secure attachment in their own child when they become adults
Treatment
Overall outcomes are not good.
Make sure the child is currently in a safe environment where emotional and physical needs are met.
Safety is first concern, need to stop neglect/abuse
Alter the relationship between the caregiver and the child, if the caregiver has caused the problem. Parenting skills classes can help with this.
The caregiver should also undergo counseling to work on any current problems, such as drug abuse or family violence.
Parents who adopt babies or young children from foreign orphanages should be aware that this condition may occur and be sensitive to the needs of the child for consistency, physical affection, and love.
If a child is over the age of 5, and has been in a foreign orphanage all their lives, may have a reactive attachment disorder
There is a romantic view of the adoption process
Need to be aware of possibility of this problem
These children may be frightened of people and find physical affection overwhelming at first, and parents should try not to see this as rejection. It is a normal response in someone who has been maltreated to avoid contact. Hugs should be offered frequently, but not forced.
