Exam 3 Flashcards
(82 cards)
1
Q
Intellectual Disability - Description of Disorder Criteria
A
- Deficits in intellectual functioning, such as reasoning, problem-solving, planning, abstract thinking, judgment, academic and experiential learning as per clinical and IQ testing.
- Deficits in adaptive functioning resulting in failure to meet standards for personal independence and social responsibility.
- Onset of IQ and adaptive functioning deficits during the developmental period
2
Q
Intellectual Disability - Severity Based On Adaptive Functioning in Conceptual, Social, and Practical Domains, Not IQ Testing
A
- Mild
- Conceptual: In preschool, difficult to tell diff., older kids/adults difficulty learning academic skills. Adults probs. w/ abstract thinking, planning, priorities, etc., poor short-term memory.
- Social: Difficulty in age-appropriate social perceptions, picking up on social cues, concrete communication, poor emotional regulation.
- Practical: Probably age-appropriate personal care; some care required for daily tasks, health care, raising a family.
- Moderate
- Conceptual: Markedly behind, language & pre-academic skills develop slowly; Academic skills develop to elementary school level in adults. On-going assistance in daily tasks requiring conceptual tasks.
- Social: Marked differences in social scenarios & communication; most relationships limited to family and accepting friends, sometimes limited romantic relationships as adults.
- Practical: Can function re. eating, dressing, elimination, hygiene as adults, but takes more intensive teaching; employment w/ basic responsibilities w/ support; can do simple games, sports and recreational exercises.
- Severe
- Conceptual: Little understanding of reading, writing, simple math, understanding time, extensive support in life
- Social: Vocab and grammar very poor, speech here & now focus, relationships limited to family & their friends
- Practical: Support in all daily activities, hygiene, bathing, dressing, etc., poor decision making, teaching intense.
- Profound
- Conceptual: non-symbolic, poor motor/sensory skills, poor functional use objects
- Social: simple instructions in speech, limited understanding of gestures, some nonverbal coms., poor emotional regulation, doesn’t initiate own social activities
- Practical: Dependent on others for all aspects of life.
3
Q
Intellectual Disability - Etiology and Prevalence
A
- Due to combinations of causes they are usually grouped into:
- Primarily biological
- Primarily physical
- Combination of the two
-30-40% causes are unknown
- Prevalent in about 2% of the population (used to be 2 SD below mean)
- 1.5 to 1 male to female ratio
4
Q
Intellectual Disability - Biological Influences
A
- Biological causes:
- chromosomal abnormalities, prenatal exposure to toxins, problems due to pregnancy, or medical conditions that develop in childhood or infancy
- Specific biological etiologies (about 80%)
- PKU
- Tay-Sachs Disease and Fragile X Chromosome Syndrome
- Down’s Syndrome (trisomy-21)
- Others:
- early deprivation of nutrition or oxygen
- HIV or viral infections
- injury to head or brain (resulting in specific problems)
- lead poisoning
- infections such as meningitis
5
Q
Intellectual Disability - PKU
A
- A rare metabolic disorder where an enzyme that breaks down phenylalanine isn’t present.
- The infant appears normal at birth, but the build up of this amino acid in the blood leads to brain damage.
- Preventable if put on a low phenylalanine diet at early age, preferably before 6 months old
6
Q
Intellectual Disability - Tay-Sachs Disease and Fragile X Chromosome Syndrome
A
-Only in males, large head, enlarged testes, violent, cognitive impairment
7
Q
Intellectual Disability - Down’s Syndrome (trisomy-21)
A
- (10-30% of all cases of moderate to severe) extra chromosome at 21st pair.
- Often have heart problems and other physical disorders
8
Q
Intellectual Disability - Psychosocial Influences
A
- Specific psychosocial causes (about 20%)
- Deprivation of nurturance
- Social and cognitive stimulation
- Poverty
- Deprivation of nurturance
9
Q
Intellectual Disability - Influences of Poverty
A
- Exposure to poverty during childhood can influence health, wellbeing, educational opportunities, and deficits in general experience.
- 28% of children with intellectual disabilities found below federal property level in comparison to 16% of non- disabled children.
- Poverty can bring exposure environmental and psychosocial hazards, which negatively affects intellectual development.
- e.g., poor nutrition, temperature extremes, environmental toxins
10
Q
Intellectual Disability - Treatment Approaches
A
- Identity skill deficits or targets for training
- Conduct task analysis (steps necessary to perform task)
- Differential reinforcement
- Shaping
- Promoting
- Fading
- Incidental Teaching
- Discrete trials
- Referrals to Association for Retarded Citizens (ARC) and other support systems
- Parent training to manage behavior problems of child
11
Q
Intellectual Disability - Identify skill deficits or targets for training
A
-Common examples: dressing, self-care skills, social skills
12
Q
Intellectual Disability - Conduct task analysis (steps necessary to perform task)
A
-Decide method of chaining to be used to teach skill
- Backward starts from last sequence in response chain, then next to last, etc.
- e.g., teaching to put on shirt.
- Forward starts from 1st sequence in response chain, then 2nd response, etc.
- e.g., teaching a child to wash dishes.
13
Q
Intellectual Disability - Differential reinforcement
A
- Reinforce desired behavior and ignore undesired behavior
- e.g., if child does stereotypies w/ hands, reinforce child for playing w/ hands
14
Q
Intellectual Disability - Shaping
A
-Reinforcing successive approximations towards the desired behavior
15
Q
Intellectual Disability - Prompting
A
-Pointing, instructing, modeling, visual cues, physical guidance
16
Q
Intellectual Disability - Fading
A
-Start with minimal level of assistance necessary and fade out assistance with increased learning
17
Q
Intellectual Disability - Incidental Teaching
A
- Wait for child to show interest in something, and elaborate on the stimulus event
- e.g., “bees bad” would be opportunity to discuss what bees do, how make honey, etc.
18
Q
Intellectual Disability - Discrete Trials
A
- prompt provided
- child responds
- consequence provided
- Example:- Therapist: What is this?
- Child: Apple
- Therapist: (delivers candy)
- consequence provided
19
Q
Specific Learning Disorder
A
-Difficulties learning and using academic skills
- 1 of the following in past 6 months despite provision of intervention targeting the deficit.
- Inaccurate/slow and effortful reading (reads single words incorrectly/slowly/hesitatingly, guesses words, difficulty sounding words out).
- Difficulty understanding meaning of what read.
- Difficulties spelling (add, omit, substitute vowels)
- Difficulties w/ written expression (multiple grammatical errors, poor paragraph organization, written ideas lack clarity)
- Difficulties mastering # sense, # facts, or calculation (lack # comprehension, magnitude, finger counting)
- Difficulties w/ math reasoning (applying math concepts, facts, procedures)
- Learning difficulties start during school age yrs.
- Not due to:
- intellectual disabilities
- sensory problems
- psychosocial adversity
- language of instruction
- inadequate educational instruction.
- The academic skills substantially and quantifiably below expected by age, causing academic/occupational/daily probs confirmed by standardized achievement tests and clinical assessment.
- 17 years and older may substitute standardized assessment w/ documented hx. of impairing learning difficulties.
20
Q
Specific Learning Disorder - Prevalence
A
- 5 to 15% in kids
- 5% in adults
- Males to Females: 2:1 to 3:1
21
Q
Specific Learning Disorder - Etiology and Prevention?
A
- Cognitive impairments in ability to process rapid, transient stimuli
- Lack of educational instruction at home
- Genetic
- Isolated chromosomes 6 and 15
- Left temporal and left parietal lobe deficits.
- Other less supported influences include exposure to:
- toxins
- early iron deficiency
- food allergies
- malnutrition
- Early Prevention Best:
- When identified in 1st or 2nd grade = 82% of youth brought up to regular classroom
- When identified in 3rd grade = 46%
- When identified in 5th to 7th grade = 13%
22
Q
Specific Learning Disorder - Treatment Approaches
A
- Reading
- Math
- Written Expression
23
Q
Specific Learning Disorder - Treatment Approaches for Reading
A
-Positive Practice
-Instruct child to read sentence
-If error occurs, say nothing until child reaches end of sentence as child may correct him/herself
-Ask child to attempt to sound out the word correctly
»If can’t pronounce word: tell child correct word and instruct child to repeat word 2 or 3 times
-Instruct child to repeat sentence
- Question Games (Ask child questions about passage)
- Start w/ 2 sentences and work up to a paragraph, page, etc.
- Start w/ easy questions and progressively get more difficult
- Be praiseworthy
- Frequent breaks but not after undesired behavior
- Focus on headings and subtitles
- Ask self-questions
- Use self-instructional training to stay on task
- Read 1st and last sentence of paragraph
- Self-rewards
- Parent rewards
24
Q
Specific Learning Disorder - Treatment Approaches for Math
A
- Teach to verbalize the steps needed to solve problem
- Self-instruct through the problem
- Positive Practice
- Instruct child to attempt math problem
- If error occurs, say nothing until child completes the problem as child may self-correct
- Show child correct solution and instruct child to solve problem 2 or 3 times
-Question Games
-To improve comprehension and excitement
»Guess what solution might be
- Be praiseworthy
- Take frequent breaks but not after undesired behavior
- Focus on instructions
- Ask self-questions
- Read 1st and last sentence of instructions for problems
- Self-rewards
- Parent rewards
25
Specific Learning Disorder - Treatment Approaches for Written Expression
-Handwriting
-1. Teacher models writing large letter while saying the name
-2. Student traces teacher’s letter while saying the name
-3. Student copies the letter while saying the name
-4. student writes the letter from memory
-5. Student practices words while providing self-instructions
»First I make one hump, then a 2nd one.
-Spelling
-Positive practice
»Child writes correct word several times
26
Pica
- Persistent eating of nonnutritive substances for at least 1 month
- Inappropriate to developmental level
- Not part of culturally sanctioned but practice
27
Pica - Prevalence
-More common in males than females, rare, may occur during infancy
28
Pica - Treatment
-Differential Reinforcement of Other behavior (DRO)
- Overcorrection
- ex. Put all cigarette butts in garbage, clean paint chips from wall and put in garbage
- Time-out (see ODD)
- Firmly state, “No!”
29
Anorexia Nervosa
- Restriction of energy intake leads to significantly low body weight
- Intense fear of gaining weight or doing things to not gain weight when too thin.
- A distorted body image
- Types:
- Restricting Type - not regularly engaged in binge-eating or purging
- Binge-Eating/Purging Type - regularly engages in binge-eating or purging
30
Anorexia Nervosa - Signs and Symptoms
- Dieting despite being thin – Severely restricted diet. Eating only certain low-calorie foods. Banning carbohydrates and fats.
- Obsession with calories, fat grams, & nutrition – Reading food labels, measuring and weighing portions, food diary, reading diet books.
- Pretending to eat or lying about eating – Hiding, playing with, or throwing away food to avoid eating. Making excuses to leave meals.
- Preoccupation with food – Constantly thinking about food. Cooking for others, collecting recipes, reading food magazines, making meal plans while eating very little.
- Strange or secretive food rituals – Refusing to eat around others or in public places. Eating in rigid, ritualistic ways (e.g. chewing food and spitting it out, using a specific plate).
- Dramatic weight loss – Rapid weight loss - no medical cause.
- Feeling fat, despite being underweight
- Fixation on body image – Obsessed w/ weight or body shape (clothing size). Frequent weigh-ins, and concern of fluctuations.
- Harshly critical of appearance – Spending a lot of time in front of the mirror checking for flaws.
- Denial of being too thin – Deny low body weight is a problem, while trying to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).
31
Anorexia vs. Bulimia
- Anorexia:
- Low body weight
- Bulimia:
- Maintain body weight
32
Bulimia Nervosa
- Frequent episodes of binge eating (w/in 2 hrs) more food than what would be typical in same time period under same circumstances;
- Recurrent inappropriate compensatory behaviors to prevent weight gain (laxatives, vomiting, exercise, diuretics)
- Compensatory behaviors occur at least 3x/wk. on average
- Self-evaluation unduly influenced by body shape and weight
- Does not exclusively occur during anorexia
33
Binge Eating Signs and Symptoms
- Lack of control over eating – Inability to stop eating. Eating until the point of physical discomfort and pain.
- Secrecy surrounding eating – Going to the kitchen after everyone else has gone to bed. Going out alone on unexpected food runs. Wanting to eat in privacy.
- Eating unusually large amounts of food - no obvious change in weight.
- Disappearance of food - empty wrappers or food containers in garbage, hidden stashes of junk food.
- Alternating between overeating and fasting – All or nothing when it comes to food.
34
Purging Signs and Symptoms
- Going to the bathroom after meals – Frequently disappear after meals. Run water to disguise vomiting.
- Using laxatives, diuretics, or enemas after eating. May also take diet pills to curb appetite, use sauna.
- Smell of vomit – May try to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.
- Excessive exercising – Works out strenuously, especially after eating. Typical activities include high-intensity calorie burners such as running or aerobics.
35
Bulimia Signs and Symptoms
- Calluses or scars on the knuckles or hands from sticking fingers down the throat to induce vomiting.
- Puffy “chipmunk” cheeks caused by repeated vomiting.
- Discolored teeth from exposure to stomach acid when throwing up. May look yellow, ragged, or clear.
- Frequent fluctuations in weight – Weight may fluctuate by 10 pounds or more due to alternating bingeing and purging.
36
Obesity - Description of Disorder Criteria
- No DSM-5 Axis 1 dx (Psychological Factor Affecting Physical Condition)
- Weight generally above 20% of that expected for height, gender, and age
37
Obesity - Prevalence
- Global obesity has tripled since 1975.
- 39% of global population overweight in 2016 (BMI 25 or > is overweight; 30 or > is obese).
- U.S. 16th most overweight nation (68% overweight; 40% obese).
38
Obesity - Etiology
-Genetics, early heavy feeding leads to increase in # of adipose cells
- Eating in response to emotional and environmental stimuli unrelated to hunger
- i.e., alleviate boredom, stress, and fatigue
- Western cultural influences
- i.e., eating a lot is praised, expressions of love associated with eating, fewer physical activities
- Cooking with large quantities of sodium, sugar, fats, and frying in oils
- Increased intake of soft drinks with added sugar
- Eating out (portion sizes are larger, less healthy)
- Multiple televisions in household
- Decrease of outdoor activities and eating while watching television leading to overeating
39
Obesity - Effects of Being Obese
- Risk for chronic disease, diminished quality of life, and poor health outcomes.
- Physical, social and psychological aspects of life
- Physical conditions will worsen in adulthood
40
Obesity - Treatment Approaches - Stimulus Control Strategies
- Eat breakfast – increase metabolism
- Eat meals in same place (not in my comfortable place), and same time.
- Eat 3 to 4 mini-meals
- Do NOT skip meals
- Do NOT eat while doing other activities
- Rewards for weight loss
- Small plates
- Eat slowly
- Discard leftovers
- Use a shopping list
- Shop when NOT hungry
- If get hungry between meals, engage in another activity
- Avoid buying foods that require no preparation (i.e., frozen food, and fast food)
- Eat bulky foods, i.e., lettuce
- No snacks or healthy snacks
- i.e., fruits and vegetables
- Leave a slight amount of food on the plate (to practice food refusal)
- Instruct family to focus on weight loss, and how good kid looks
- Weigh self frequently and focus on weight loss
- Exercise programs/activities
- Jogging with family or joining sports team at school
- Teach parents CAIR (cues, activity, intake, rewards)
- Self-monitoring
- Cook food with less quantities of sodium, sugar, fats, and frying in oils
- Eating spicy food
- Increase in metabolism, eat smaller portions, better for digestion
41
Encopresis - Description of Disorder
- Repeated passage of feces in inappropriate places at least once per month for 3 months
- Must be at least 4 yrs.
- Can’t be due to medical condition or substances (e.g., laxatives)
- Primary type: continence never established
- 2ndry type: develops after period of continence
42
Encopresis - Prevalence
- 1% of 5 yr.-olds have encopresis.
- More common in males than females.
- Less prevalent with age.
- Treatment Approaches
43
Encopresis - Treatment
- Azrin’s dry pants.
- Teach to recognize the cues.
- Harder to tx. than enuresis due to lower frequency of accidents
44
Enuresis - Description of Disorder
- Repeated voiding in bed or clothes, whether intentional or not
- Clinical significance (i.e., 2x per week for 3 consecutive months, distress or impairment)
- At least 5 years old.
- Not due to medical disorder or substance
- Specify if nocturnal only, diurnal only, or both
45
Enuresis - Prevalence
- 5 - 10% of 5 yr.-olds
- 3% of 10 yr.-olds
- 1% of 15 yr.-olds.
- Nocturnal more prevalent in boys, diurnal more prevalent in girls
46
Enuresis - Treatment
- Azrin’s dry bed for nocturnal
| - Azrin’s dry pants for day
47
Anorexia Nervosa - Prevalence
- 0.5 to 1% in females
- 4-8% of anorexics are men
- about 10:1 ratio of female to male
-5-7% prevalence in at-risk groups (dancers, models, middle/upper incomes)
48
Anorexia Nervosa - Etiologies
-Emphasis of culture on thinness leads to rigid beliefs regarding dieting
- Dysfunctional families marked by
- excessive perfectionist demands
- enmeshed
- overprotective
- rigid/demanding
- Poor conflict resolution skills
- Genetic causes triggered by traumatic separations and family discord
- Few or no friends
- Positive reinforcement for dysfunctional eating
49
Anorexia Nervosa - Treatment
- Contingency management
- Usually limited to inpt. due to need to control contingencies
- Reinforces: exercise, jogging, walks, social interactions, passes from hospital, discharge from hosp., no intravenous feeding
- No more effective than programs that focus on discharge contingencies based on weight gain
- Social skills training
- No improvements in weight gain relative to control, but improvements in depression, anxiety, fear of negative evaluation
- 1st teach to identify what their role is in life, and what those roles communicate to, and elicit from, others
- Discuss how current non-assertive skills are beneficial and protective
- Antecedent control
- Coping skills to assist youth in eliminating antecedents to binges (e.g., boredom, anxiety, interpersonal, dietary restriction)
- Exposure and response prevention (if binging/purging type)
- Group or individual
- Explain that binge occurs consequent to triggers of anxiety, so expose to triggers/eating and prevent purging behavior
-Cognitive restructuring: questions regarding body image, food weight beliefs, interpersonal relations, perfectionist thoughts
50
Bulimia - Prevalence
- 1-2% prevalence
- 10:1 female to male
- 4-19% of all young females engage in clinically significant levels of bulimic behavior
- Mean onset = 17-19 years
51
Bulimia - Etiologies
- Sexual abuse
- Family conflict
- Family hx. of drug abuse
- Impulsivity
- Slower metabolism (eat less frequently, thus slows down metabolism)
- Genetics
- Depression or anxiety leading as precursors
- Extreme dieting leads to hunger and risk for binge
- Chronic depression
- Low self-esteem
- Triggered by traumatic separations and family discord
52
Bulimia - Treatment
- Exposure and response prevention
- Establish hierarchy of forbidden foods
- Expose to hierarchy during session
- Eat taboo foods during session until uncomfortable
- Focus thoughts on sensations of being full
- Record SUDS every 2 mins.
- Prevent or delay from purging, and encourage to verbalize thoughts and feelings re. eating fears.
- Eat at least 3 meals, ideally 6 mini-meals
- Reduces binge eating by reducing hunger which is caused by skipping meals
- Response Delay
- Teach bulimic to delay binge (call a friend, wash car)
- Good for clients who have not yet made the commitment to stop vomiting
- Self-monitoring of binge eating
- Monitor and record associated and preceding thoughts, feelings, and stimulus events
- Self-monitoring binge and purge episodes,
- Review % full prior to binge/purge
- Concurrent thoughts
- Cognitive methods
- Identify problem situations, and associated self-statements than use cognitive restructuring.
- Challenge “shoulds” and “musts”
- Praise small signs of independent and competent living, assertiveness, flexibility
53
Autism Spectrum Disorder
- 1. Persistent deficits in social interaction and communication in multiple contexts:
- a) Deficits in multiple nonverbal behaviors (poorly integrated verbal and nonverbal interaction, odd eye-to-eye contact, facial expression)
- b) Deficits in developing, maintaining, and understanding relationships (lack of sharing in imaginative play, absence of interest in friends)
- c) Deficits in social or emotional reciprocity (abnormal approach, maintenance of conver., initiate social activity, share emotions)
- 2. Restricted, repetitive patterns of behavior, interests or activities:
- a) Stereotyped or repetitive movements, use of objects, or speech (stereotypies, lining up toys, echolalia, idiosyncratic phrases)
- b) Insistence on sameness, inflexible adherence to routines, or ritualized patterns of behavior (distress at small changes, rigid thinking, odd greeting rituals, eat same food everyday, take same routes)
- c) Highly restricted, fixated interests that are abnormal in intensity or focus (attachment to unusual objects)
- d) Hyper or Hypoactivity to sensory input or unusual interest in sensory aspects of the environment (indifference or hypersensitivity to pain, adverse response to sounds or textures, excessive use of senses)
- 3. Symptoms must be present in early developmental period
- 4. Symptoms cause clinical impairment in social or occupational functioning.
- 5. Not due to intellectual disability.
- 6. 3 levels of Severity:
- Level 3 = Requiring very substantial support
- Level 2 = Requiring substantial support
- Level 1 = Requiring support
54
Autism Spectrum Disorder - Prevalence
-4-5x more prevalent in males, occurs equally across SES
- Recent CDC estimates as high as 1 in 59 children
- Much higher than estimates in past 1 in 10,000 in late 1980s.
- Possibilities for increase
- Higher survival rates for premature infants at greater risk for developmental disabilities
- Greater awareness may prompt caregivers to seek out dx. at earlier ages.
55
Autism Spectrum Disorder - Etiology
- Genetic predisposition
- 8% have extended family member with autism.
- 3-5% have a sibling w/ autism.
- Increase in brain weight,
- Delayed maturation of frontal cortex
- Truncated dendritic tree development of neurons in the limbic system.
- Brainstem and cerebellum abnormalities.
- Epilepsy and other electrocephalographic abnormalities.
- Ventricle enlargement
- Hydrocephalus
- Abnormal levels of serotonin and dopamine
- About ½ speak, 70% diagnosed w/ mental retardation.
56
Autism Spectrum Disorder - Treatment
- Medications: neuroleptics (e.g., Haloperidol) to help aggression, withdrawal, emotional lability, self-harm.
- Very intensive training.
- Mild verbal aversives (No!) for self-abusive behavior & Time Out
- Discrete trials (applied behavioral analysis): prompt, response, reinforcing stimulus
57
Autism Spectrum Disorder - Discrete Trials
- Present a brief, salient stimulus
- Instruction or question, e.g., Look at Me)
- Prompt correct response initially (hand guiding face)
- Fade prompt with correct responding (moving hand toward face, then retract hand)
- 2. Child responds
- 3. Provide consequence (“good,” edible)
58
Physical Abuse
- Infliction of injury by a caretaker
- Beating
- Punching
- Kicking
- Biting
- Varied Symptoms:
- Shame
- Often cry
- Aggression
- Depression
- Drug abuse
- Confidence
- Running away
- Low self-esteem
- Suicidal ideation
- Sexual acting out
- Poor weight gain
- Substance abuse
- Conduct disorders
- Behavior problems
- Social skill deficits
- Including dating skills
- Unsure of likes/dislikes
- Compulsive compliance
- Low academic achievement
- Poor language development
- Infants evince difficulty sleeping and feeding, older children evidence of poor social skills,
- Toddlers evince problems comprehending intensity of emotions in others,
- Avoidant behavior with distress (won’t ask for assistance),
- Angry when others are distressed (Mash & Barkley, 95),
- Increased reliance on how parents expect them to act,
- Dissociate themselves from chaotic environments,
- Adolescents lack assertiveness.
59
Physical Abuse - Prevalence
-About a quarter of all child abuse reports
60
Physical Abuse - Etiology
- Marital problems
- Single family home
- Parental unemployment
- Perpetrator abused as kid
- Poor community resources
- Reliance on corporal punishment
- Poor housing conditions and negative life events lead to stress
- Poor social support (leads to lack of appropriate feedback, lack of respite)
- Parenting Skill Deficits:
- Disciplining
- Teaching skills
- Impulse control
- Expressing affection
- Problem-solving skills
- Unrealistic expectations
- Faulty attributions of child’s behavior
- Difficult Child Characteristics:
- ADHD
- Crying
- Irritability
- Immoral behavior
- Substance Abusive Caregiver:
- Increases irritability
- Decreases tolerance
- Lessens supervision which leads to undesired behavior which leads to abuse
61
Physical Abuse - Treatments
- Multimodal approach using empirically-derived interventions:
- Child Management Skills Training
- Stress Management
- CBT
- Child CBT
- Parent CBT
- Family Behavior Therapy
62
Physical Abuse Treatment - Child Management Skills Training
-Emphasize positive reinforcement through parent skills-based training.
63
Physical Abuse Treatment - Stress Management
- Solicit welfare services (e.g., shelter assistance, securing food)
- Anger management
- Problem-solving for kids and caregivers
- Providing social networking skills training
- Assisting relationship of child with guardian ad litem/CASA volunteers
- Assisting family in joining social networks
- Churches, community center events, boys/girls clubs
64
Physical Abuse Treatment - Cognitive Behavioral Therapy
-Parents and children seen in separate sessions (clinic and home visits)
- Child CBT:
- Discussion of
- Family stressors and violence
- Relaxation
- Constructive thinking
- Negative assertion skills training using interpersonal skills to avoid risk of harsh discipline
Parent CBT
- Discussion of
- Stress and views of physical violence
- Anger control
- Cognitive restructuring
- Influences of child to do misconduct such as child development and expectations.
- Child management training (attends, ignoring, response cost)
- Family Behavior Therapy (not sure if goes here or is separate)
- Educating about effects of abuse, communication skills training, self-control, environmental control, job club, financial management, behavioral contracting, emergency management
65
Physical Abuse Treatment - Family Behavior Therapy
-Educating about effects of abuse, communication skills training, self-control, environmental control, job club, financial management, behavioral contracting, emergency management
66
Sexual Abuse
-Sexual behavior between a child or adult, or between 2 children when 1 is significantly older or uses coercion (touching sexual organs dressed or undressed, exhibitionism, fellatio, cunnilingus, and penetration of vagina or anus w/ sexual organs or objects).
- Varied Symptoms
- 1/3 of sexually abused kids don’t show symptoms
- Positive correlates of severity of symptoms w/ abuse:
- Frequency of acts/duration of abuse
- Close relationship between child and perpetrator
- Lack of maternal support during time of abuse
- Poor coping skills
- Rage
- PTSD
- Aggressive
- Self-blame
- Drug abuse
- Mood disorders
- Low self-esteem
- Eating disorders
- Suicidal ideation
- Itching vagina/anus
- Elimination disorders
- Stomach/headaches,
- Overly compliant/passive
- Poor achievement in school
- Inappropriate sexual behaviors
- Mistrust, interpersonal problems
67
Sexual Abuse - Prevalence
- About 35% of girls and about 13% of boys in childhood
| - Both boys and girls are most vulnerable to abuse between the ages of 7 and 13
68
Sexual Abuse - Treatments
-Trauma-Focused CBT and Behavioral Treatment for Sexual Abuse Program
- Parent Sessions
- Provision of emotional support
- Behavior management skills training
- Address attributions of responsibility
- Provision of legal information, support in court
- Assist in coping with parents’ own victimization, if present
- Kid Sessions
- Thought stopping
- Contingency management
- Personal safety skills training
- Problem-solving skills training
- Addressing regressive behaviors
- Discussing feelings about the offender
- Addressing inappropriate sexual behaviors of kid
- Graduated exposure to traumatic event
69
Child Abuse: Neglect
- Willful failure to provide adequate care and protection for children.
- Failure to feed child adequately
- Provide medical therapy
- Provide education
- Protect child from harmful or dangerous situations
- Symptoms of Victim:
- Poor impulse control
- Gives up easily
- Doesn’t demonstrate enthusiasm
- Poor language development
- Low IQ
- Low positive affect
- Withdrawn, passive
70
Child Abuse: Neglect - Prevalence
-About half of all abuse cases (50%)
71
Child Abuse: Neglect - Etiologies
- Parenting skill deficits in
- Disciplining
- Expressing affection
- Teaching skills
- Unrealistic expectations
- Faulty attributions as to child’s undesired behavior
- Impulse control, problem-solving skills
- Parental unemployment
- Single family home
- Poor community resources
Poor housing conditions
- Negative life events lead to stress
- Marital problems
- Substance abusive caregiver
- Increases irritability
- Decreases tolerance, etc.
- Lessens supervision which leads to undesired behavior which leads to abuse
-Poor social support (leads to lack of appropriate feedback, lack of respite)
- Difficult child characteristics
- Crying
- Irritability
- Immoral behavior
- ADHD so can’t focus on what asked to do
- Perpetrator abused as kid
- Reliance on corporal punishment
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Child Abuse: Neglect - Treatment
- Ecobehavioral Approach (Project SafeCare, Project 12-Ways)
| - Family Behavioral Therapy
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Child Abuse: Neglect - Treatment: Ecobehavioral Appraoch (Project SafeCare, Project 12-Ways)
- Use of behavioral strategies to treat various problems within the family
- Child management skills training, teaching parents to recognize illnesses and injuries and seek appropriate care, teaching families appropriate hygiene, home safety tours
- Home safety tours with family to ameliorate home hazards
- The following categories are monitored each week during a home tour:
- Toxins
- Electrical
- Sharp objects
- Heavy objects
- Small objects
- Weapons
- Home access
- Adequate temperature control
- Adequate food
- Cleanliness
- Household items
- Adequate toys
- Adequate books
- Adequate clothing
- Adequate decor
- For each home hazard, a check is recorded in a monitoring form
- The family is asked to determine a solution and the therapist assists in brainstorming solutions.
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Child Abuse: Neglect - Family Behavioral Therapy
- Emergency Management
- Behavioral Goals and Rewards
- Treatment Plan
- Stimulus Control
- Self-Control
- Financial Management
- Communication Enhancement
- Positive Request
- Job-Getting
- Concluding Treatment and Generalizing Results
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Child Abuse: Psychological Abuse
- Conveying to a child that he/she is worthless, flawed, unloved, unwanted, or endangered
- Perpetrator may spurn, terrorize, isolate, or berate the child, repeatedly taking the child to unnecessary medical therapy.
- Evidence for relationship between emotional abuse and emotion regulation difficulties, even after controlling for the impact of physical and sexual abuse.
- Treatments are limited, and usually included within other abuse types
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Nightmare Disorder - Description
- Repeated extended, dysphoric, well-remembered dreams.
- Usually involves threats to survival, or horror.
- Become oriented soon after awakening
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Nightmare Disorder - Prevalence
-Up to 50% of 3-5 yr.-old kids have nightmares
- Nightmares occur often in 1 to 4% of kids have them often or always
- increases as go through childhood (about 6% in adults).
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Nightmare Disorder - Treatment
- Stimulus Control
- Eliminate fighting in family
- Eliminate scary television/books
- No caffeine prior to bed
- Exercise during day but not prior to bed
- Consistent bed routines, i.e., standard bedtime, read books
- Fade out light if fears of dark.
- Fade out parental attention (e.g., sleeping in bed to standing outside room, to checks)
- Wake child the next morning at early time if sleeping poor.
- Eliminate noise during child’s sleeping.
- Prevent child from sleeping in parent’s bed after nightmare
- Dream Mapping
- Construct positive event with child to dream about w/ details
- Teach parents to help younger children w/ prompts/cues
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Non-Rapid Eye Movement Sleep Arousal Disorder
- Recurrent episodes of incomplete awakening from sleep:
- 1) Sleep Terror (Recurrent abrupt awakenings from sleep, usually w/ scream)
- 2) Sleep Walking (rising from bed during sleep/walking about)
- Blank stare, relatively unresponsive to others, hard to wake
- Intense fear and autonomic arousal
- Relatively unresponsive to being comforted
- Can’t recall dream, screaming or event
- Often disoriented or confused after awakening
- Usually over intervals of days or weeks, not consecutively
- Not dreams cause occur in deeper nonREM stages 3 and 4
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Non-Rapid Eye Movement Sleep Arousal Disorder - Etiology
- Enlarged adenoids and immature central nervous system
- Tends to run in families
- Poor history of sleep, i.e., frequent awakenings w/ crying
- Deprivation of sleep may cause irregularities in sleep patterns which lead to terrors.
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Non-Rapid Eye Movement Sleep Arousal Disorder - Prevalence and Onset
- Terror episodes = 4%
- Usually go away by teens.
- Onset usually between 4 to 12 years.
- Spontaneously remits during adolescence for most
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Non-Rapid Eye Movement Sleep Arousal Disorder - Treatment
-Wait, and see if disappear (if less severe)
- Antidepressants (e.g., imipramine) or benzodiazepines
- These drugs tend to reduce amount of time spent in nonREM sleep (i.e., particularly stages 3 and 4)
- Efficacy is weak
- Scheduled Awakenings and stable bedtime
- One 90 min. session w/ parents
- Explain rationale that scheduled awakenings allow child to spend more time in REM sleep (i.e., terrors do not occur during REM sleep)
- Explain 4 stages of progressively deeper sleep (NonREM sleep) and REM
- NREM cycle is 75 mins. in children (90 in adults)
- In REM body is non-active but brain is active
- In NREM body is active and brain is not
- NREM is when sleepwalking and sleep terrors and sleep awakenings occur
- REM is when nightmares occur
- Sleep talking occurs during both REM and NREM
- Conduct baseline on sleep data (later use chart during treatment)
- Schedule 1st awakening to occur 30 mins. prior to expected 1st sleep terror awakening,
- Gently nudge child back and forth until child awakens
- Allow to go back to sleep as soon as child wakes up
- Fade awakenings, such that after 7 nights w/out terror, skip 1 night’s awakening, and reduce 1 awakening per wk. of sound sleep thereafter
