Exam 3 Flashcards
What influences abnormality?
-culture
-adults determine abnormality, not children
-some cultures more open to all childhood behaviors and expressions (Thai-Buddhist beliefs)
-some cultures stricter on what is “normal” in childhood expression (USA)
What aspects of culture influence the way children develop?
-Social learning through peers or adults
-What they see in the media (TV, books, movies)
-Religion
-School that you went to
When do we notice abnormality in children?
-Typically once entering school
-Behaviors at home are “tolerated” or not seen as problem behaviors
-Starting school = stressor -> onset of symptoms
-Resulting from identifiable trauma/stressor
-Abuse, neglect
-In children, emotional and verbal abuse shown to have just as significant effects as physical/sexual abuse
How many children are diagnosed with a mental health disorder?
-1 in 6 children (~18%) aged 2-8 has a mental, behavioral, or developmental d/o
-49.5% of adolescents have had a MH disorder at some point in their lives
-15% major depressive episode, 37% persistent feelings of sadness or hopelessness
-4% SUD, 3% illicit drug use d/o
-19% seriously consider suicide, 9% attempted suicide, 2.5% suicide attempt requiring medical treatment
What are the most common disorders for children to be diagnosed with?
-Learning disorders (11%)- impairments in reading, writing, and math
-ADHD (9.6% of children 6-11, 13.6% of adolescents 12-17)
What is disruptive mood dysregulation disorder (DMDD)?
-Characterized by chronically unstable mood, heightened irritability, intense disruptive behaviors in children ages 6-18
-Outbursts, tantrums, and aggression to meet needs not being met otherwise
Prevalence: 2.5% of children
What is the diagnostic criteria for DMDD?
-Severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation or provocation
-Outbursts are inconsistent w/ developmental level
-3+ outbursts a week
-Persistently irritable or angry
-Sxs for 12+ months
-Diagnosed between 6-18
-Sxs onset before 10
What are attachment-related disorders?
-Housed with trauma-related disorders
-Specific to children = attachment-related disorders
-Reactive Attachment Disorder
-Disinhibited Social Engagement Disorder
What is attachment theory?
Young children need to develop a relationship with at least one primary caregiver for normal social and emotional development
What is secure attachment?
Reassured
May show distress at leave but soon recovers
Seek comfort in caregiver when frightened
Most common ~60%
What is ambivalent insecure attachment?
Very distressed at caregivers’ leave
Cannot depend on caregiver die to poor parental availability
Consider uncommon 7-15%
What is avoidant insecure attachment?
Avoid caregivers
Shows no preference for caregiver over a stranger
May be results of abusive or neglectful caregivers or who were punished by caregivers for seeking help of comfort when frightened
Roughly ~30%
What is RAD?
Characterized by a lack of social and emotional responsiveness and no desire to form relationships with or seek comfort from caregivers
What is DSED?
Characterized by the inability to form safe boundaries with strangers, over-emotionality, and demanding attention in new relationships
What are characteristics of a RAD diagnosis?
Extreme insufficient care
Rarely seeks or responds to comfort
Child is at least 9 months and evident before 5 years
Relatively rare <10% neglected children
What are characteristics of a DSED diagnosis?
Approaches and interacts with unfamiliar adults
Not limited to impulsivity
At lease 9 months old
What are the differences between RAD and DSED?
RAD: lack of emotionality, unpredictable responses, withdrawn form caregivers, no desire to connect with caregivers, doesn’t seek comfort, avoids eye/social contact
DSED: extreme emotionality, caregiver no different than stranger, rarely checks in with caregiver in unfamiliar settings, friendly, needy, clingy with strangers, invading social boundaries, demands attention
What are disruptive behavior disorders?
ODD and Conduct Disorder
-Two most common child and adolescent disorders seen in counseling practice
What are the conflict with authority types in disruptive behavior disorders?
Less severe: temper tantrum, arguing
Severe: ignore rules, noncompliance to authority
More Severe: school trauma, breaking curfew, running away
What are the types of destruction of property-threat issues with disruptive behavior disorders?
Less severe: shoplifting, lying
Severe: vandalism, fire setting
More severe: fraud, burglary, pit pocketing
What are the types of issues associated with aggression towards others with a disruptive behavior disorders?
Less severe: annoying others, playing rough
Severe: fighting, cruelty to animals
More severe: SA/rape, physical assault, murder
What is oppositional defiant disorder (ODD)?
Characterized by defiant and disobedient behavior marked by hostile and negative demeanor
“Milder” form of conduct disorder
Typically targeted toward authority figures
Prevalence: 1-11%
What are the diagnostic criteria for ODD?
Angry or irritable for at least 6 months
Four or more symptoms
Targeted towards at least one individual who is not a sibling
What is ODD in younger children vs older children?
Younger children: tantrums, difficulty to soothe, low tolerance to frustration, irritability, shirt-fused with emotional expression
Older children and adolescents: low-self esteem, low self-worth, aggressive, malicious towards others, initiate verbal/physical altercations, cursing, drug/alcohol experimentation/use
What is conduct disorder characteristics?
Characterized by an enduring and repetitive pattern of defiance marked by deceitful, hostile, and destructive behaviors that violate self and others
Prevalence 2-10%
Conduct disorder diagnostic criteria
Three or more criteria for past 12 months
At least one criteria from the past 6 months
If over 18 does not meet criteria for ASPD
What are the overt behaviors of conduct disorder?
Observable behaviors that directly impact others
Physical altercations, theft, assault
More often in men
What are covert behaviors of conduct disorder?
Less confrontational
Lying, cheating, deceiving others, truancy
More often in women
How to tell ODD and Conduct Disorder apart?
ODD: losing temper, arguing w/ authority figures, annoying others, defiance, disobedience, hostile and negative behavior, usually directed at authority, does not have severe impairment in social/school,personal life
Conduct Disorder: threatens others, initiates fights, committing crimes, marked by deceit, hostility, destruction, violating self and others, severe impairment legally/school/socially
What is ADHD?
Neurodevelopmental, neurological processing disorder
Most widely know cause is a deficit of dopamine, norepinephrine, and serotonin neurotransmitters (responsible for transmitting messages between neurons)
Deficit in these-> erratic mood changes, attentional issues
7.2% of children (Typically school aged children)
2.5% of adults
What are common characteristics of ADHD?
Attention irregularities, rather than attention deficiencies
Struggle to attend to tasks
Unique ability to hyper focus on tasks that interest them
Hyperactive behavior
“Acting out”
What are ADHD diagnostic criteria?
6 or more inattention or hyperactivity/impulsivity
Sxs prior to age 12
Several sxs in 2 or more symptoms
What are additional considerations of ADHD?
One of the most commonly misdiagnosed disorders worldwide
Boys are more likely to be diagnosed
What is psychosis?
A cluster of symptoms
What are psychotic disorders?
A disorder characterized by psychotic symptoms
What are the 5 symptoms of psychosis?
Delusions
Hallucinations
Disorganized thoughts/speech
Disorganized or abnormal motor behaviors
Negative symptoms
What are delusions?
Strongly fixed beliefs
Beliefs not grounded in reality
Inflexible even when presented with contrary evidence
What are persecutory delusions?
Person or object is trying to hurt you
What are referential delusions?
Unsuspicious occupancies refer to them
Interpreting messages as being sent to them
What are somatic delusions
Has a medical problem or physical issue
What are religious delusions?
Personal religious belief that does not align with culture
What are bizarre delusions?
Implausible or bizarre beliefs
Alien invasion, organs being replaced
How do delusions affect thoughts?
Thought broadcasting: thoughts are somehow transmitted to the external world
Thought insertion: thoughts have been planted in their mind by an external source
Thought with drawl: thoughts have been removed from ones mind
What are hallucinations?
Lifelike experiences in which person senses something despite a complete lack of external stimulus
All five senses
Auditory, visual, olfactory, gustatory, tactile
What is disorganized speech or thought like?
Switching of topics “derailment” or “loose associations”
Unrelated answered to questions
Jumbled sentences
Made-up words
What is disorganized or abnormal motor behavior?
Catalonia: abnormality of movement and behavior arising from disturbed mental state
Absence of interaction with others (mutism)
Resistance to movement (negativism)
Lack of movement or speech
Mimicking others movement or speech
Repetition
What are negative symptoms?
Missing or not present
Lack of positive emotions
Decrease is speech
What is schizophrenia?
Presence of delusions, hallucinations, disorganized speech, disorganized/cataonic behavior, or negative symptoms
What are diagnostic criteria for schizophrenia?
2 or more sxs during a 1 month period
Markedly low achievement prior to onset
At least 6 months
What are brain differences that occur with schizophrenia?
Larger ventricles
Loss/thinning of grey matter = ability to control movement, memory, emotions, sensory processing
Dopamine levels
Neurotransmitter used to send messages between nerve cells, affects behavior and physical functions
Too much dopamine
What is brief psychotic disorder?
Characterized by presence of psychotic sxs similar to those seen in schizophrenia, but in a short amount of time
No less than a day, no longer than a month
Typically in response to an extreme stressor
What’s the diagnostic criteria for brief psychotic disorder?
One or more sxs with at least one being delusions, hallucinations, or disorganized speech
Full return of functioning within one month
What is delusional disorder?
Characterized by the presence of delusions in the absence of other psychotic symptoms
Challenge with this d/o
Potentially plausible stories (tend to be non bizarre delusions)
What are delusional disorder diagnostic criteria?
One or more delusions lasting 1 month or longer
Does not meet criterion a for schizophrenia never been met
Functioning not markedly impaired, behavior is not obviously bizarre or odd apart from the impact of the delusion and its ramifications
What are delusional disorder subtypes?
Erotomanic type: beliefs related to romantic relationships
Grandiose type: central theme of the delusion of that one has a great but unrecognized talent or insight or having made some important discovery
Jealous type: ones partner is being unfaithful
Persecutory type
Somatic type
How to recognize delusional disorder?
Beliefs tend to be time consuming
Asking more questions
Identify behaviors around the belief
What is schizoaffective disorder?
Presence of both psychotic and mood disturbances
Experience psychosis
Concurrently and mood episodes and in the absence of mood episode
Generally better cognitive functioning than schizophrenia
What is the diagnostic criteria for schizoaffective disorder?
Major mood episode concurrent with criteria a of schizophrenia
Delusions for 2+ weeks in absence of major mood episode
Major mood episode sxs preset for majority of total duration
