Exam 3 Flashcards
what characteristics do resilient children or adolescents have?
temperament that can adapt to changes in the environment; ability to form nurturing relationships with other adults when a parent is not avialable; social intelligence - can read people (expressions and faces and figure out how things are going in a situation and what you need to do); ability to use problem-solving skills
what is the prevalence of children or adolescents having a major psychiatric disorder?
one in five children have one
how many young people with a mental problem are not receiving the help that they need
an estimated 2/3 of all young people
what percent of 21 year olds that have mental disorders have had a previous disorder?
75%
what barriers to treatment of children and adolescent behaviors is there a lack of?
clarity about why, when, and how of screening; coordination of funding and eligibility systems; resources; mental health providers; adequate reimbursement
what does genetics have to do with children and adolescent mental disorders?
often times their parents are diagnosed with a problem as well
what does temperament have to do with children and adolescent mental disorders?
some children can adapt and some can’t, whether or not they have a mental disorder often has to do with how well they can adapt
what do biochemical factors have to do with children and adolescents?
some of them as the same as adults; often have to do with serotonin, norepinephrine, and dopamine
what types of environments increase the chances for the development of mental disorders in children and adolescents?
low socioeconomic status; large families; marital issues; abuse; parental criminality; maternal psychiatric disorders; foster care placement
how is the mental status assessment of a child or adolescent different from that of an adult?
similar to that of adults except that the developmental level is considered
what does the developmental assessment provide information on?
the child’s current maturational level that, when compared with the child’s chronological age, identifies developmental lags and deficits
what ages is the denver II designed for?
infants and children up to 6 years of age
what are methods of collecting data on children and adolescents with mental disorders?
interviewing, testing, observing, and interacting; histories from parents and caregivers (teachers are really important); questions answered about life at home and school; free to describe current problems; games, drawings, puppets and free play unable to respond to a direct approach; important observations of interactions among, child, adolescent, caregiver, and siblings
what questions should you ask about the mental health assessment of children and adolescents?
what is the level of emotional and intellectual maturity?; what are the child or adolescents particular strengths?; what particular strengths and weaknesses are present?; what stresses does the child encounter?; how do stressors affect young people at different stages of development?
what was the intellectual development disorder formerly known as?
mental retardation
what can causes of IDD be?
heredity, alterations in early embryonic development, pregnancy or perinatal problems, other factors such as trauma or poisoning
what does intellectual disability include deficits in?
reasoning, problem solving, planning, abstract thinking, judgement, academic learning, and learning from experience
what deficits in general mental abilities occur with IDD?
deficits in daily activities such as communication, functioning at school or work, personal independance, and impairment in cognitive functioning
what is the median age for the earliest diagnosis for autistic spectrum disorder?
4.5-5.5 years of age
what must someone demonstrate in order to be diagnosed with autistic spectrum disorder?
two or more of the following: stereotyped or repetitive speech, motor movement, and echolalia (the repetitive use of objects); excessive adherence to routines, rituals, or excessive resistance to change; fixated interests that are abnormal in intensity; hyporeactive or hyperreactive rate to the sense of joy or unusually interest and sensory aspects of the environment
what deficits do people with ASD have?
social and emotional reciprocity; verbal and nonverbal communicative behaviors used for social isolation; developing and maintaining relationships, appropriate to the developmental level
what things should you assess for in children with ASD?
developmental spurts and lags, uneven development, or loss of previously acquired abilities; quality of relationship between child and parent (evidence of bonding, anxiety, tension, and difficulty of fit between parent, child, and caregiver temperaments); co-occurring conditions; child’s strengths; at risk for abuse
are there medications available to treat ASD?
no
what is risperidone used to treat in children with ASD?
the symptoms of aggression, deliberate self injury, and/or temper tantrums, but propranolol is preferred because it has lower side effects; SSRIs may also be used but cautiously
what are some goals for long-term outcomes of ASD?
attain an increased interest in reciprocal interactions; provide for the development of psychomotor skills; facilitate appropriate expression of emotions and development of cognitive skills; foster the development of social skills, self-concept, and self control (including impulse control)
what percentage of children are affected by ADD and ADHD?
3-10% of children and adolescents
what are the three cardinal signs of ADHD and ADD?
intattention, hyperactivity, impulsivity
what are some predisposing factors for ADD and ADHD?
family history and perinatal or prenatal influences
what do brain scans of children with ADD or ADHD reveal?
underdeveloped or inactive frontal lobes - a lot of their behavior is the brain trying to stay awake and stay functional
what type of ADD or ADHD is more common in females?
the ‘inattentive type’ the day dreamers
what are interventions for the child with ADD and ADHD?
behavior modification and pharmacological agents that address inattention and hyperactive impulsive behaviors; special education programs that address academic difficulties; psychotherapy and play therapy to determine emotional problems
what is the most widely used medication to treat ADD and ADHD?
methylphenidate (Ritalin) which is available orally, the transdermal form is Daytrana
what is concerta?
an extended-release Ritalin that allows for once-daily dosing
what is Adderall?
a combination of dextroamphetamine and amphetamine that also calms and comes in an extended release form
what are some side effects of pharmacological interventions for ADD and ADHD?
decreased appetite, decreased sleep, increased VS
what should you monitor for the child taking medications to treat ADD or ADHD?
monitor weight, appetite, sleep and vital signs
what medication treats aggression and insomnia in the child with ADD or ADHD?
guafacine HCl
what are tics?
stereotyped, rapid, and involuntary recurring motor movements that include excessive blinking, facial grimacing, shoulder shrugging, and head turning. wax and wane over time
what is the average onset of tourette disorder?
may appear by age 2, but has an average onset between 6 and 7
how long is tourette disorder?
usually lifelong with periods of remission
what part of the body does tourette disorder usually affect?
usually the head, but can also affect the torso and limbs
what is coprolalia?
the uttering of obscenities that is present in less than 10% of cases
how common is Tourette’s disorder?
affects 4-5 persons in 10,000 and is more common in males
what things should you assess for in someone with Tourette’s disorder?
symptoms include obsessions, compulsions, hyperactivity, distractibility, and impulsivity; low self-esteem is common, feeling ashamed, self-conscious, and rejected by peers; fear of tics in public situations limits activities; CNS stimulants increase the severity of tics; children with co-existing ADHD must have their medications monitored carefully because they are treated with stimulants
what is the focus of treatment for Tourette’s disorder?
helping the child, family, and school understand and cope with tic behavior
what are the most effective drugs used to treat Tourette’s disorder?
clonidine HCl and guanfacine HCl
what disorders are common with Tourette’s disorder?
OCD, disruptive, impulsive, and conduct disorders
what is ODD characterized by?
angry mood and headstrong behavior that is persistent and frequent - they are the mouthy kids
what should you assess with ODD?
quality of child-parent-caregiver relationship (bonding anxiety, tension, and difficulty of fit between the parent and child’s temperaments can contribute to these problems); parent or caregiver’s understanding of growth and development and parenting skills (lack of knowledge contributes to the development of these problems); lags or deficits in cognitive, psychosocial, and moral development result in disruptive behaviors
when does childhood onset of conduct disorder occur mainly?
occurs mainly in male children before the age of 10 years
what are the symptoms of childhood-onset conduct disorder?
physically aggressive, has poor relationships, shows little concern for others, and lacks guilt and remorse
what should you assess with conduct disorder?
seriousness of disruptive behavior; possible hospitalization or residential placement; levels of anxiety, aggression, hostility, and impulse control; and assess the moral development of the ability to understand the effects of hurtful behaviors on others, to empathize with others, and to feel remorse
what should you do during the interview of a child or adolescent with conduct disorder
have support available in case hostility escalates, and position self in a safe spot
what things should you do for a child or adolescent with conduct disorder?
protect from harm, and provide for needs; provide immediate nonthreatening feedback for unacceptable behaviors; provide immediate positive feedback for acceptable behaviors; increase the ability to control impulses using role play; foster identification with positive role models; foster the development of realistic self-identity; provide education and guidance for parents and care givers
what is the most common mental disorder in childhood and adolescents? what is the prevalence?
anxiety disorders are the most common. they affect 13% of youth age 9-17
how might anxiety in children be displayed?
in more somatic complaints like headaches and stomach aches
what things may anxiety disorders develop into in adulthood?
agoraphobia, GAD, panic disorders, specific phobias, and a social phobia
what is separation anxiety?
an anxiety particular to children in which they experience extreme anxiety when separated or anticipating separation from familial surroundings; the panic is overwhelming and excessive
if not treated what can separation anxiety lead to later in life?
panic disorder with agoraphobia
what things should you assess in a child with anxiety?
quality of child-parent-caregiver relationship; recent stressors and severity; parents or caregivers understanding of developmental norms, parenting skills, handling of problematic behaviors; whether or not regression has occurred; assess child’s previous and current ability to separate from parent or caregiver; separation and individualization process may not be completed or the child may have regressed; assess for presence of anxiety problems in the parent or caregiver
what should be the first option of treatment for a child or adolescent with an anxiety disorder?
therapy and counseling
when are medications used to treat a child or adolescent with an anxiety disorder?
only when psychotherapy is unsuccessful and anxiety levels are incapacitating
what medications are the most effective for anxiety disorders in children and adolescents?
SSRIs
what things should you do for a child or adolescent with an anxiety disorder?
foster developmental competencies and coping skills; protect from panic levels of anxiety; accept regression and give emotional support; offer positive reinforcement for small victories, don’t use negative reinforcement because this may increase anxiety
how may a child with PTSD react differently than an adult
they may show behaviors indicative of internalized anxiety rather than reliving the traumatic event
how do preschool age children demonstrate PTSD?
they generally internalize behaviors that may exhibit sleep difficulties, night mares or terrors, reliving trauma in repetitive play of the event, increase in specific fears, irritability, angry outbursts, temper tantrums, separation anxiety, somatic complaints
how do school age children demonstrate PTSD?
generally externalize PTSD and exhibit sleep difficulties somatic complaints, irritability/increased fighting, impaired academic performance, repetitive playing out to traumatic event, feeling jumpy, belief that life will be short, “omen formation”, feelings of detachment/estrangement from others
when is the typical onset of somatic symptom disorder?
usually before age 30
what are common complaints of somatic symptom disorder?
long list of somatic complaints, pain, dysphagia, GI issues (big connection between IBS and anxiety), SOA, palpitation, have fainting spells with no reason for the fainting
why do people with somatic complaints have unnecessary health care costs?
because they demand tests that don’t really need to be run and they go “dr. shopping” until they get a dr that will tell them what they want to hear
what is thought to be an underlying factor in somatic symptom disorders?
anxiety and depression
what is the diagnosis when they can’t find any cause for somatic pain in patients?
somatic symptom disorder with pain
what usually happens if you treat the underlying psych problems in somatic symptom disorder?
the somatic complaints will go away, but they often refuse psych treatment
what are secondary gains that people get from somatic symptom disorder?
attention and freedom from daily responsibilities
are people with somatic symptom disorder faking their symptoms?
no, we don’t see them, but they are real to them. it might just be psych pain that is manifesting itself physically
disorder that includes extreme concern and preoccupation with having a devastating disease. they might not have a physical illness, but they are preoccupied with it even when they have been tested and nothing has come up
illness anxiety disorder (hypochondiasis)
what are common symptoms of conversion disorder?
paralysis, blindness, movement and gait disorders, numbnress, paresthesias, loss of vision or hearing, or episodes resembling epilepsy
what are the ways in which people with conversion disorder show their concern?
they are either not concerned at all or are extremely concerned with it (la belle indifference vs distress)
who is conversion disorder more common in?
females, people in lower socioeconomic group, lower education levels, history of severe trauma
how may genetic and familial factors play a role in somatic symptom disorder?
it may cause them to exhibit feelings more physically than emotionally and they may have a lower pain threshold
how might learning and sociocultural factors play a role in somatic symptom disorder?
they may have had early experiences that play a role or they may be a little more sensitive to somatic experiences
what does the interpersonal theory say about somatic symptom disorder?
they may have grew up in a rough environment with a lot of adversity and abuse; they may have a traumatic background
what are some ways that people from African and Southern Asian cultures might demonstrate somatic symptoms?
burning hands and feet; worms in the head; ants under the skin
how should you assess symptoms of patients with somatic symptom disorder?
OLDCARTS; how do they describe their symptoms (are they dramatic)
do people with somatic symptom disorder have voluntary control over their symptoms?
no, they are not consciously trying to make it up and lie to you - you might see the connection to psych, but they don’t
what things should you assess with a patient with somatic symptom disorder?
symptoms and unmet needs, voluntary control of symptoms, secondary gains, cognitive style, ability to communicate feelings and emotional needs, dependence on medications
what are some basic level interventions for somatic symptom disorders?
promotion of self-care activities, health teaching and promotion (address lower education level), case management, pharmacological interventions (get at underlying anxiety and depression)
what are some advanced level interventions for a patient with somatic symptom disorder?
psychotherapy
when can you diagnose somatic symptom disorder?
only when you rule out all medical causes
disorder in which the patinet deliberately fabricates symptoms of illness or self-injury without obvious gains. they want to assume ‘sick-role’
factitious disorder
how far do people with facticious disorder go to have the symptoms that they want?
far enough that they could be inducing the symptoms theirselves, they may exaggerate symptoms or make some things up
what is muchausen syndrome?
the most serious form of facticious disorder in which the patient is trying desperately to make themselves sick - they go so far that they may inject themselves with things to make them sick, contaminate lab orders, push for treatments
why is muchausen syndrome so dangerous?
they could accidentally kill themselves in trying to make themselves sick
what is mallingering?
consciously feigning an illness for obvious benefit
what are dissociative disorders?
disturbances in the normally well-integrated continuum of consciousness, memory, identity, and perception - unconscious defense mechanism. this protects the individual from overwhelming anxiety.
what is an altered mind-body connection?
a patient might become enraged and ‘lose their mind’ and then when they calm down, they have blacked out for that point of time
what is depersonalization?
alteration in the perception of self, might think they are seeing themselves from a distance, reality testing intact, disturbing experiences of sense of deadness of body, seeing oneself from a distance, perceiving limbs to be larger or smaller than normal
what is derealization?
experience of unreality of surrounding, reality testing remains intact
what is dissociative amnesia?
the inability to recall important personal information often due to trauma or stress
what is the difference between generalized and local amnesia?
with generalized they cannot remember anything, while with localized they only block out certain things around the stressor
what is dissociative amnesia with fugue?
sudden unexpected travel away from the customary locale; inability to recall one’s identity and some or all of the past; during the fugue stat they tend to live simple, quiet lives; when former identity remembered, they become amnestic from time spent in the fugue state; don’t remember the time when they had the amnesia, but while they have the amnesia they don’t remember the time before that
what occurs during dissociative identity disorder?
there is a presence of two or more distinct personality states (usually more than two); primary personality is not aware of the alters; alternate personalities take control of behavior; alters are often aware of each other and each alter thinks and behaves as a separate individual; stressors send them into these alters
what biological factors may be affected with a dissociative disorder?
the limbic system plays a role and serotonin levels may be affected
what are psychological factors that could cause dissociative disorder?
they are trying to avoid or suppress any kind of severe traumatic event; the more they try to suppress those memories, the more likely they are to dissociate
what things do children and adolescents with a high degree of competency have in common?
more available resources than nonadapting children; average or better than average intellectual skills; good parenting or mentor figure; less vulnerable to stress
