Final Exam (Chapter 9 to 14) Flashcards
1
Q
Conduct Problems
A
A wide range of age-inappropriate actions and attitudes of a child that violate family expectations, societal norms, and the personal or property rights of others.
2
Q
Antisocial Behaviours
A
A broad term used to describe conduct problems that range from minor disobedience to fighting.
3
Q
Social and Economic Costs
A
Early, persistent, and extreme patterns of antisocial behaviour occur in about 5% of children, but they account for over 50% of all crime in the US and 30-50% of clinic referrals.
4
Q
Oppositional Defiant Disorder (ODD)
A
A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at least 6 months and exhibited during interaction with at least one individual who is not a sibling.
5
Q
Conduct Disorder (CD)
A
A repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested in symptoms of aggression toward people and animals, destruction of property, deceitfulness or theft, or serious violations of rules.
6
Q
Childhood-Onset Conduct Disorder
A
Display at least one symptom of conduct disorder before age 10, tend to be boys, show more aggressive symptoms, and persist in their behaviour over time.
7
Q
Adolescent-Onset Conduct Disorder
A
Do not display symptoms of conduct disorder before adolescence, as likely to be girls as boys, and do not display as much severity or psychopathology.
8
Q
What is Antisocial Personality Disorder?
A
APD is an adult disorder characterized by a pervasive pattern of disregard for, and violation of, the rights of others, as well as engagement in multiple illegal behaviors.
9
Q
What are Psychopathic Features?
A
Psychopathic features are a pattern of callous, manipulative, deceitful, and remorseless behavior displayed by adolescents with CD or APD.
10
Q
What is the CU interpersonal style?
A
The CU interpersonal style is a callous and unemotional style characterized by an absence of guilt, lack of empathy, uncaring attitudes, shallow or deficient emotional responses, and related traits of narcissism and impulsivity.
11
Q
What are the characteristics of youths with CD and LPE?
A
The DSM-5 uses the specifier “with limited prosocial emotions (LPE)” to describe youths with CD who display a persistent and typical pattern of interpersonal and emotional functioning involving at least two of the following three characteristics: lack of remorse or guilt, callous—lack of empathy, and unconcerned about performance.
12
Q
What are the cognitive and verbal deficits associated with CD?
A
Verbal IQ is consistently lower than performance IQ in children with CD, suggesting a specific and pervasive deficit in language. Children with both verbal deficits and family adversity display four times as much aggressive behavior as children with only one factor. CD children also show deficits in executive functioning.
13
Q
What are the school and learning problems associated with CD?
A
Many young children display patterns of disruptive behavior long before they enter school, so it is likely that a common factor underlies both conduct problems and school difficulties. Subtle early language deficits may lead to reading and communication difficulties, which in turn may heighten conduct problems in elementary school.
14
Q
What are the family problems associated with CD?
A
General family disturbances include parental mental health problems, family history of antisocial behavior, marital discord, family instability, limited resources, and antisocial family values. Specific disturbances in parenting practices and family functioning include excessive use of harsh discipline, lack of supervision, lack of emotional support and involvement, and parental disagreement about discipline.
15
Q
What are the peer problems associated with CD?
A
The combination of early antisocial behavior and associating with deviant peers is a powerful predictor of conduct problems during adolescence. Friendships between antisocial boys are abrasive, unstable, of short duration, and not very productive. Reactive-aggressive children display a hostile attribution bias, while proactive-aggressive children are more likely to display emotional underarousal, view their aggressive actions as positive, and value social goals of dominance and revenge rather than affiliation.
16
Q
What are the self-esteem deficits associated with CD?
A
Aggressive children may overestimate their social competence and acceptance by other children. Any perceived threat to their biased view of self may lead to aggressive behavior, which provides a way to avoid a lowering of self-concept.
17
Q
What are the health-related problems associated with CD?
A
Youths with conduct problems engage in many behaviors that place them at high risk for health-related problems, including personal injuries, illnesses, sexually transmitted diseases, and substance abuse.
18
Q
Accompanying Disorders: ADHD
A
More than 50% of children with CD also have ADHD
Two lines of research suggest that they are distinct disorders
19
Q
Accompanying Disorders: Depression and Anxiety
A
About 50% of youths with conduct problems also have depression or anxiety
Co-occurring anxiety has been identified as a protective factor that inhibits aggressive behavior
20
Q
Prevalence and Gender
A
Lifetime prevalence estimates are 12% for ODD and 8% for CD. Boys have higher rates of conduct problems than girls, with an earlier age of onset and greater persistence
21
Q
What is the Developmental course?
A
Difficult temperament in early childhood may indicate conduct problems later. Most children with CD add new forms of antisocial behavior over time. About 50% of children with CD improve over time
22
Q
What is the Life-Course-Persistent Pathway?
A
aggression and antisocial behavior from early age continuing into adulthood, perpetuated by its own consequences and family history of externalizing disorders.
23
Q
What is the Adolescent limited path
A
antisocial behavior beginning around puberty, continuing into adolescence, but ceasing during young adulthood.
24
Q
What are Adult Outcomes for conduct disorders?
A
Outcomes depend on type and variety of conduct problems, number and combination of risk and promotive factors in child, family, and community. Significant number of children with conduct problems continue to experience difficulties as adults, including criminal behavior, psychiatric problems, social maladjustment, health and employment problems, and poor parenting.
25
In causes, what is the role of genetic influences for conduct disorders?
adoption and twin studies indicate 50% or more of variance in antisocial behavior is attributable to heredity for both males and females, parents pass on general liability for externalizing disorders to their children.
26
In causes, what is the role of prenatal factors and birth complications in conduct disorders?
malnutrition during pregnancy, maternal drug or alcohol use, mothers’ smoking during pregnancy.
27
In causes, what is the role of neurobiological factors in conduct disorders?
Gray's behavioral activation system (stimulates behaviour in response to signals of reward or nonpunishment) and behavioral inhibition system (produces anxiety and inhibits ongoing behaviour in the presence of novel events, innate fear stimuli, and signals of nonreward or punishment)
28
What is the role of social-cognitive factors in conduct disorders?
social-cognitive abilities involve skills in attending to, interpreting, and responding to social cues. Dodge and Pettit propose cognitive and emotional processes play a central mediating role: children are presumed to develop social knowledge about their world based on a unique set of predispositions, life experiences, and sociocultural contexts, which they then use to guide their processing of social information in ways that lead directly to certain behaviours
29
How can positive parenting practices affect children's genetic risk for antisocial behavior?
Positive parenting practices may reduce the influence of a child’s genotype on later antisocial behavior, while negative parenting practices can have the opposite effect.
30
Are family difficulties related to both ODD and CD?
Yes, family difficulties are related to the development of both ODD and CD, with a stronger association for children on the LCP as compared with those on the AL path.
31
Which is a stronger predictor of later conduct problems: hostility between parents or interparental disengagement and low levels of interparental cooperation?
Hostility between parents is a stronger predictor of later conduct problems than interparental disengagement and low levels of interparental cooperation.
32
Can contact with an absent father be both a risk and a protective factor for antisocial behavior?
Yes, contact with an absent father can be either a risk or a protective factor depending on whether or not the father is antisocial.
33
What is the reciprocal influence theory?
The reciprocal influence theory is the theory that a child’s behavior is both influenced by and itself influences the behavior of other family members.
34
What is coercion theory?
Coercion theory is a developmental theory proposing that coercive parent-child interactions serve as the training ground for the development of antisocial behavior.
35
What are some examples of four-step escape-conditioning sequences proposed by coercion theory?
According to coercion theory, a child learns how to use increasingly intense forms of noxious behavior to escape and avoid unwanted parental demands through four-step escape-conditioning sequences.
36
Are there relationships between children with conduct problems and parent/societal standards?
Children with conduct problems often show little internalization of parent and societal standards.
37
Is there a relationship between children with insecure/disorganized attachments and the development of antisocial behavior during childhood and adolescence?
Yes, there is a relationship between children with insecure/disorganized attachments and the development of antisocial behavior during childhood and adolescence.
38
Are families of children with conduct problems often characterized by an unstable family structure?
Yes, families of children with conduct problems are often characterized by an unstable family structure, with frequent transitions, including changes in parents and changes in residence.
39
What is the amplifier hypothesis?
The amplifier hypothesis states that stress amplifies the maladaptive predispositions of parents, thereby disrupting family management practices and compromising parents’ ability to be supportive of their children.
40
Are antisocial individuals likely to be effective parents?
No, antisocial individuals are likely to be ineffective parents.
41
Are children’s aggression correlated with their parents’ childhood aggression at the same age?
Yes, children’s aggression is correlated with their parents’ childhood aggression at the same age, and this relationship is particularly clear for fathers
42
What do theories of social disorganization propose?
Theories of social disorganization propose that community structures impact family processes that then affect the child’s adjustment.
43
Are adverse contextual factors associated with poor parenting?
Yes, adverse contextual factors (e.g., low SES) are associated with poor parenting, particularly coercive and inconsistent discipline and poor parental monitoring.
44
What does the social selection hypothesis state?
The social selection hypothesis states that people who move into different neighborhoods differ from one another before they arrive, and those who remain differ from those who leave.
45
Can a good school environment partially compensate for poor family circumstances?
Yes, a good school environment may partially compensate for poor family circumstances.
46
What are the short term and long term effects of exposure to media violence?
Exposure to media violence can be both a short term precipitating factor for aggressive and violent behaviour that results from priming, excitation, or imitation of specific behaviours, and a long term predisposing factor for aggressive behaviour acquired via desensitization to violence and observational learning of an aggression-supporting belief system.
47
What are some cultural factors that contribute to antisocial behavior in the US?
Minority group status and ethnicity are risk factors for antisocial behaviour in the US.
48
What are some restrictive approaches to treating and preventing antisocial behavior, and what are their limitations?
Restrictive approaches such as residential treatment, inpatient psychiatric hospitalization, and incarceration also show little effectiveness, are associated with worse physical and mental health outcomes in adulthood.
49
When should early-onset antisocial behavior be treated as a chronic condition?
If early-onset antisocial behaviour is not changed by the end of grade 3, it might best be treated as a chronic condition, much like diabetes, which cannot be cured but can be managed or contained through ongoing treatment.
50
What is the underlying assumption of Parent Management Training (PMT)?
The underlying assumption of PMT is that maladaptive parent-child interactions are partly responsible for producing and sustaining the child's antisocial behavior.
51
What does PMT teach parents?
PMT teaches parents to change their child's behavior at home and in other settings.
52
With which age group has PMT been most effective?
PMT has been most effective with parents of children younger than 12 years of age and less so with adolescents.
53
What is PSST?
PSST is a form of cognitive-behavioral therapy that focuses on the cognitive deficiencies and distortions displayed by children and adolescents with conduct problems in interpersonal situations.
54
What are the five problem-solving steps taught in PSST?
The child is taught to use five problem-solving steps to identify thoughts, feelings, and behaviors in problem social situations:
1. What am I supposed to do?
2. I have to look at all my possibilities.
3. I had better concentrate and focus.
4. I need to make a choice.
5. I did a good job or I made a mistake.
55
What is Multisystemic Therapy (MST)?
MST is an approach to treatment that attempts to address the multiple determinants of problematic behavior by involving family members, school personnel, peers, juvenile justice staff, and others in the child's life and by drawing on multiple techniques.
56
What are the main assumptions of preventative interventions?
The main assumptions of preventative interventions are:
1. Conduct problems can be treated more easily and more effectively in younger than in older children.
2. By counteracting risk factors and strengthening promotive factors at a young age, it is possible to limit or prevent the escalating developmental trajectory of increased aggression, peer rejection, self-esteem deficits, conduct disorder, and academic failure that is commonly observed in children with childhood-onset conduct problems.
3. Preventative interventions will reduce the substantial costs to the educational, criminal justice, health, and mental health systems that are associated with conduct problems.
57
Q: What is a mood disorder?
A mood disorder is a disorder characterized by extreme, persistent, or poorly regulated emotional states.
58
What are the two major types of mood disorders?
The two major types of mood disorders are depressive disorders and bipolar disorders.
59
What is dysphoria?
Dysphoria is a state of prolonged bouts of sadness.
60
What is anhedonia?
Anhedonia is a state in which a person feels little joy in anything they do and loses interest in nearly all activities.
61
What is irritability?
Irritability refers to easy annoyance and touchiness, characterized by an angry mood and temper outbursts.
62
What is mania?
Mania is an abnormally elevated or expansive mood, increased goal-directed activity and energy, and feelings of euphoria, which is an exaggerated sense of well-being.
63
How many children and adolescents in the US suffer from significant depression each year?
More than 3 million children and adolescents in the US suffer from significant depression each year.
64
Why is depression in children often overlooked?
Depression in children is often overlooked because disruptive behaviors attract more attention and are more easily observed than internal, subjective suffering.
65
What is major depressive disorder?
Major depressive disorder is a disorder characterized by depressed or irritable mood, loss of interest or pleasure, other symptoms, and significant distress or impairment in functioning that has a minimum duration of two weeks.
66
What is persistent depressive disorder or dysthymia?
Persistent depressive disorder or dysthymia is a disorder characterized by depressed or irritable mood, generally fewer, less severe, but longer-lasting symptoms than MDD and significant impairment in functioning.
67
What is disruptive mood dysregulation disorder?
Disruptive mood dysregulation disorder is a disorder characterized by frequent and severe temper outbursts that are extreme overreactions to the situation or provocation and chronic, persistently irritable or angry mood that is present between the severe temper outbursts.
68
What are the lifetime prevalence estimates for depression?
The lifetime prevalence estimates for depression are 11%-20%.
69
What percentage of young people with depression have one or more other disorders?
90% of young people with depression have one or more other disorders.
70
What are the most frequent co-occurring disorders in youths with MDD?
The most frequent co-occurring disorders in youths with MDD are anxiety disorders, particularly generalized anxiety disorders, specific phobias, and separation anxiety disorders.
71
What is stress sensitization?
Stress sensitization occurs when externally produced changes in the brain can be conditioned so that following the first depressive episode, individuals are increasingly vulnerable to stress, and even nonsevere stress or minor events that resemble loss or stress experiences may result in depression.
72
Who is more likely to suffer from depression, males or females?
Females are twice as likely to suffer from depression than males.
73
What coping styles do girls use to deal with stress?
Girls use ruminative coping styles to deal with stress, focusing on the symptoms of distress and its causes rather than on solutions.
74
Do nonwhite adolescents report more symptoms of depression than white adolescents?
Nonwhite adolescents do report more symptoms of depression than white adolescents, but this likely reflects differences in SES since lower SES and depression are linked.
75
What is Persistent Depressive Disorder (P-DD)?
People who suffer from P-DD experience symptoms of depressed mood that occur for most of the day, on most days, and persist for at least one year. Some children with P-DD experience double depression, in which MDD is superimposed on the child’s previous P-DD, causing the child to present with both disorders.
76
What is the prevalence of P-DD and what is its most prevalent co-occurring diagnosis?
1% of children and 5% of adolescents display P-DD. The most prevalent co-occurring diagnosis is Major Depressive Disorder (MDD).
77
What are the onset, course, and outcome of P-DD?
P-DD develops about 3 years earlier than MDD, most commonly around 11-12 years of age. Deficits in psychosocial functioning may either precede or follow P-DD. Almost all children eventually recover from P-DD but they also have an extremely high risk of developing other disorders, especially MDD or anxiety disorders or CD.
78
What is Disruptive Mood Dysregulation Disorder (DMDD)?
The central feature of DMDD is chronic, severe persistent irritability. It has two main clinical features: frequent verbal or physical temper outbursts that usually occur in response to frustration and are totally out of proportion to the provocation or situation, and a chronic and persistent irritable or angry mood that is present most of the day, nearly every day, between the severe temper outbursts.
79
Why was the DMDD category develope
The development of the DMDD category was a response to increasing rates of bipolar disorder diagnoses in young children; it was intended to provide an alternative to diagnosing Bipolar disorder in young children too frequently.
80
What are the associated characteristics of depressive disorders related to intellectual and academic functioning?
Certain depressive symptoms—difficulty concentrating, loss of interest, and slowness of thought and movement—are likely to have a harmful effect on a child’s intellectual and academic functioning. The association between the severity of depression and children’s overall intelligence is weak, suggesting that the effects of depression on cognitive functions may be selective.
81
What are the cognitive biases and distortions associated with depression?
Many children with depression experience biases, deficits, and distortions in their thinking. To focus narrowly and passively on negative events for long periods is referred to as a depressive ruminative style.
82
What is negative self-esteem and how is it related to depression?
Low self-esteem is the depression symptom that seems mostly specifically related to depression in adults. Perceived incompetence in areas of physical appearance and approval from peers may heighten the risk for depression.
83
What are the social and peer problems associated with depression?
Young people with depression have few friends or close relationships, feel lonely and isolated, feel that others do not like them, and display extensive impairments in their social skills. Children who report poor friendships at the time of referral have a reduced likelihood of recovery from depression. Their best friends may display higher rates of psychopathology. Depressed youth use less active and problem-focused coping and more passive, avoidant, ruminative, or emotion-focused coping. Co-rumination is a negative form of self-disclosure and discussion between peers focused narrowly on problems or emotions to the exclusion of other activities or dialogue. Co-rumination is associated with higher ratings of friendship quality and closeness.
84
What family problems are associated with depression?
Depressed youth report feeling socially isolated from their families and prefer to be alone rather than with them. Children with depression who are irritable, unresponsive, and unaffectionate provide little positive reinforcement for their parents and frustrate their parents’ desire for satisfaction in the parenting role.
85
What are the statistics on depression and suicide among youths?
Most youths with depression report suicidal thinking, and about 30% who think about killing themselves actually attempt it.
86
What are the different theories of depression?
The theories of depression include psychodynamic, attachment, behavioural, cognitive, self-control, interpersonal, socioenvironmental, and neurobiological.
87
What is the psychodynamic theory of depression?
Early psychodynamic theories viewed depression as the conversion of aggressive instinct into depressive affect. Depression is presumed to result from the loss of a love object, an actual loss or a symbolic loss; the individual’s rage toward the love object is then turned against the self.
88
What is the attachment theory of depression?
Bowlby hypothesized that a child confronted with unresponsive and emotionally unavailable caregiving goes through a typical sequence involving protest, despair, and detachment. Children with insecure attachments are more likely than children with secure attachments to display symptoms of depression.
89
What is the behavioural theory of depression?
Behavioural views emphasize the importance of learning, environmental consequences, and skills and deficits during the onset and maintenance of depression. Depression is related to a lack of response-contingent positive reinforcement, which may occur for three reasons.
90
What is the cognitive theory of depression?
Cognitive theories emphasize depressogenic cognitions, which are the negative perceptual and attributional styles and beliefs associated with depressive symptoms. Depressed individuals show cognitive problems in three areas: information-processing biases, the negative cognitive triad, and negative cognitive schemata.
91
What are other theories of depression?
Self-control theories view youths with depression as having difficulty organizing their behavior in relation to long-term goals and as displaying deficits in self-monitoring, self-evaluation, and self-reinforcement. Interpersonal models view disruptions in interpersonal relationships, especially with family and peers, as the basis for the onset and maintenance of depression. Socioenvironmental models emphasize the relationship between stressful life events and depression. The diathesis-stress model of depression proposes that the occurrence of depression depends on the interaction between the subject’s personal vulnerability and life stress. Neurobiological models of depression in young people focus on genetic vulnerabilities and neurobiological processes.
92
What are the causes of depression?
Genetic and family risk factors are significant causes of depression. Heritability estimates range from 30-45% across studies for males and females. The child’s risk for depression is even higher when both parents have a mood disorder. No specific region on the chromosome makes a large contribution to the risk of MDD and multiple regions are involved.
93
What are the brain regions that are affected in individuals with depression?
Brain scan studies have identified multiple alterations in the structure and function of the medial prefrontal networks of the brain (anterior cingulate cortex, ventromedial, and orbitofrontal cortex) and related subcortical regions (amygdala and ventral striatum) which disrupt the processing of, and regulation of responses to, emotional and motivationally salient stimuli and events.
94
How do families of children with depression typically behave towards their depressed child?
Families of children with depression display more critical and punitive behaviour toward their depressed child than towards other children in the family. When their children display negative emotions and distress, mothers with a history of depression are less likely to respond supportively with comfort, empathy, or assistance and are more likely to disapprove, dismiss, punish, or ignore their child’s negative emotions.
95
What does emotion regulation refer to?
Emotion regulation refers to the processes by which emotional arousal is redirected, controlled, or modified to facilitate adaptive functioning and the balance maintained among positive, negative, and neutral mood states.
96
What problems can prolonged periods of emotional distress and sadness in young children lead to?
Young children who experience prolonged periods of emotional distress and sadness may have problems in regulating their negative emotional states and may be prone to the development of depression.
97
What type of therapy has shown the most success in treating adolescents with depression?
Cognitive-behavioural therapy (CBT) has shown the most success in treating adolescents with depression.
98
What is the integrated approach derived from two traditions that most psychosocial interventions for depression in young people use?
Most psychosocial interventions for depression in young people use an integrated approach derived from two traditions—behaviour therapy and cognitive therapy.
99
What is the PASCET model?
Primary and Secondary Control Enhancement Training (PASCET) is a psychosocial intervention that focuses on primary control skills for changing objective events in their lives to conform with their wishes, and secondary control skills for altering the subjective impact of stressful life events.
100
What is the ACTION model?
The ACTION model is a psychosocial intervention that emphasizes the following strategies: Always find something to do to feel better, Catch the positive, Think about it as a problem to be solved, Inspect the situation, Open yourself to the positive, and Never get stuck in the negative muck.
101
What type of drugs have been recommended as the first line of treatment for children with depression?
SSRIs have been recommended as the first line of drug treatment for children with depression, but concerns have been raised about their use.
102
What type of programs should be given a high priority to prevent depression in young people?
A high priority needs to be given to programs aimed at preventing depression in young people.
103
What is bipolar disorder and how is it diagnosed in young people?
Bipolar disorder is a type of mood disorder characterized by extreme highs and lows. An episode of mania is an abnormally elevated or expansive mood, while feelings of euphoria are an exaggerated sense of well-being. In young people, a diagnosis of bipolar I disorder requires the occurrence of at least one lifetime manic episode, while bipolar II disorder requires a hypomanic episode in combination with one or more major depressive episodes. Cyclothymic disorder describes children or adolescents who display numerous and persistent hypomanic and depressive symptoms for a year or more that cause considerable distress and impairment in functioning but don't meet criteria.
104
What is the prevalence of bipolar disorder in young people and what comorbidities are commonly associated with it?
Life prevalence estimates of BP in youths 7 to 21 are 0.5% to 2.5% worldwide. Co-occurring disorders such as anxiety, ADHD, ODD, CD, substance-use problems, and suicidal ideation are extremely common in youths with BP.
105
When does bipolar disorder typically onset in young people and what are the causes?
About 60% of patients with BP experience their first episode prior to the age of 19 years, with a peak age of onset between 15 and 19. It affects males and females about equally. Family and gene studies with adults indicate that BP is the result of a genetic vulnerability in combination with environmental factors, such as life stress or disturbances in the family. Brain-imaging studies point to abnormalities in emotion regulation, including the amygdala and anterior cingulate cortex.
106
What is the recommended treatment for bipolar disorder in young people?
BP in young people requires a multimodal treatment plan with education of the patient and the family about the illness, medication, and psychosocial interventions to address the youth’s symptoms and related psychosocial impairments.
107
What are anxiety disorders?
Anxiety disorders are a group of mental health conditions characterized by excessive and debilitating anxiety.
108
What are the key features of anxiety?
Anxiety is a mood state characterized by strong negative emotion and an element of fear.
109
Why do children experience anxiety?
Anxiety is an adaptive emotion that readies children physically and psychologically for coping with people, objects, and events that could be dangerous.
110
What is the neurotic paradox?
The neurotic paradox is the pattern of self-perpetuating behavior in which children who are overly anxious in various situations, even while being aware that the anxiety may be unnecessary or excessive, find themselves unable to abandon their self-defeating behaviors.
111
What are the symptoms of anxiety?
The symptoms of anxiety are expressed through three interrelated response systems: the physical system, the cognitive system, and the behavioral system.
112
What happens in the physical system when a person experiences anxiety?
When a person perceives or anticipates danger, the brain sends messages to the sympathetic nervous system, which produces the fight/flight response.
113
What happens in the cognitive system when a person experiences anxiety?
The activation of the fight/flight system produces an immediate search for a potential threat. Children with anxiety disorders struggle to focus because their attention is consumed by a constant search for threat or danger.
114
What happens in the behavioral system when a person experiences anxiety?
The fight/flight response comes with overwhelming urges to exhibit aggression or escape the threatening situation.
115
What is the difference between anxiety and fear?
Fear is an immediate alarm reaction to current danger or life-threatening emergencies, while anxiety is future-oriented.
116
What is panic?
Panic is a group of physical symptoms of the flight/fight response that unexpectedly occur in the absence of any obvious threat or danger.
117
What are normal fears, anxieties, worries, and rituals?
Normal fears, anxieties, worries, and rituals are behaviors that serve a useful function in normal development.
118
What are anxiety disorders according to DSM-5?
DSM-5 specifies several types of anxiety and related disorders based on types of reaction and avoidance.
119
What is Separation Anxiety Disorder?
Separation Anxiety Disorder (SAD) is a condition in which children experience excessive distress related to separation from their parents or other major attachment figures and fear of being alone, which is age-inappropriate and disabling.
120
What is the prevalence and comorbidity of Separation Anxiety Disorder?
SAD is found in about 4-10% of all youths worldwide and is more prevalent in girls. About 2/3 of children with SAD have another anxiety disorder, and about half develop a depressive disorder later.
121
What is the onset, course, and outcome of Separation Anxiety Disorder?
SAD has the earliest onset of all anxiety disorders, typically beginning at 7-8 years old, and generally progresses from mild to severe. SAD persists into adulthood for more than 1/3 of children.
122
What is school reluctance and refusal?
School reluctance and refusal is defined as the refusal to attend classes or difficulty remaining in school for an entire day. A fear of school may be associated with submitting to authority and rules outside the home, being compared with unfamiliar children, and experiencing the threat of failure.
123
What is Specific Phobia?
Specific Phobia is a condition in which children display a marked fear or anxiety about specific objects or situations for at least 6 months. If the fear is encountered regularly or causes significant distress or interference with important life events, it can become a serious problem. DSM-5 categorizes specific phobias into five subtypes based on the focus of the phobic reaction and avoidance: animal; natural environment; blood/injection/injury; situational; other.
124
What is the prevalence and comorbidity of Specific Phobia?
About 20% of youths experience specific phobias at some point in their lives, and they tend to have multiple phobias.
125
What is the onset, course, and outcome of Specific Phobia?
The onset of Specific Phobia is generally 7-9 years of age, and it peaks between 10 and 13 years old.
126
What is Social Anxiety Disorder (Social Phobia)?
Social Anxiety Disorder (SOC) or social phobia is a marked and persistent fear of social or performance requirements that expose children to scrutiny and possible embarrassment, including fear of performance situations and fear of interaction situations.
127
What is the prevalence, comorbidity, and course of Social Anxiety Disorder (Social Phobia)?
The lifetime prevalence of Social Anxiety Disorder is 6-12%, with twice as many girls as boys affected. It is the most common secondary diagnosis for children referred for other anxiety disorders and generally develops after puberty.
128
What is Selective Mutism?
Selective Mutism is a condition in which children fail to speak in specific social situations in which there is an expectation to speak, even though they may speak at home or in other settings.
129
What is the prevalence, comorbidity, and course of Selective Mutism?
Selective Mutism occurs in 0.7% of all children in community samples and does not vary by sex or ethnicity. It often co-occurs with Social Anxiety Disorder (SOC) and Specific Phobia. The average age of onset is 3-4 years.
130
What is Panic Disorder and Agoraphobia?
Children with panic disorder (PD) experience recurrent unexpected panic attacks followed by at least one month of persistent concern or worry about having another attack and its consequences or a significant change in their behavior related to the attacks in order to avoid having them. Agoraphobia is characterized by marked fear or anxiety in certain places or situations.
131
What is a Panic Attack?
A panic attack is a sudden and overwhelming period of intense fear or discomfort that is accompanied by four or more physical and cognitive symptoms characteristic of the fight/flight response.
132
What is the prevalence and comorbidity of Panic Disorder and Agoraphobia?
Panic attacks affect 16% of teens, and agoraphobia affects 2.5% of teens. Females are twice as likely as males to be affected.
133
What is the onset, course, and outcome of Panic Disorder and Agoraphobia?
The average age of onset for the first panic attack is 15 to 19. PD and agoraphobia are stable over time and have one of the lowest rates of complete remission for any anxiety disorder.
134
What is Generalized Anxiety Disorder (GAD)?
GAD is a form of anxiety disorder in which the subject experiences chronic or exaggerated worry and tension, almost always anticipating disaster, even in the absence of an obvious reason to do so.
135
What is the prevalence and comorbidity of Generalized Anxiety Disorder (GAD)?
The lifetime prevalence rate of GAD is 2.2%, and it is the most common anxiety disorder diagnosis.
136
What is the onset, course, and outcome of Generalized Anxiety Disorder (GAD)?
The average age of onset is early adolescence. Older children present with higher numbers of symptoms and higher levels of anxiety, but this may diminish with age. Severe GAD symptoms persist over time.
137
What are Obsessive-Compulsive and Related Disorders?
Obsessive-Compulsive and Related Disorders include Body dysmorphic disorder, Hoarding disorder, Trichotillomania, and Excoriation disorder.
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What is Obsessive-Compulsive Disorder (OCD)?
OCD is a disorder in which the individual experiences recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted and that in most individuals cause marked anxiety or distress. The individual attempts to ignore or suppress such thoughts, urges, or images or to neutralize them with some other thought or action. Obsessions are persistent and intrusive thoughts, urges, or images that are experienced as intrusive and unwanted. Compulsions are repetitive, purposeful, and intentional behaviors or mental acts that are performed in response to obsessions in an attempt to suppress or neutralize them.
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What is the prevalence and comorbidity of Obsessive-Compulsive Disorder (OCD)?
The lifetime prevalence of OCD is 1-2.5%, and it is twice as common in boys.
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What is the onset, course, and outcome of Obsessive-Compulsive Disorder (OCD)?
The average age of onset is 9-12 years with two peaks, in early childhood and early adulthood. Two-thirds continue to have the disorder 2 to 14 years after being diagnosed.
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What are the associated characteristics of anxiety disorders?
Children with anxiety disorders typically have normal intelligence, but high levels of anxiety can impact academic performance. They also display cognitive disturbances, such as threat-related attentional biases and cognitive errors and biases, physical symptoms like stomachaches and headaches, and social and emotional deficits, including low social performance and high social anxiety. Anxiety and depression are also associated, and girls experience symptoms of anxiety about twice as much as boys.
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What is the relationship between gender, ethnicity, and culture with anxiety in children?
About twice as many girls as boys experience symptoms of anxiety, and this difference is present in children as young as 6 years of age. Children's ethnicity and culture may affect the expression and developmental course of fear and anxiety, how anxiety is perceived by others, and expectations for treatment.
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What are the early theories of anxiety and phobias?
Classical psychoanalytic theory views anxieties and phobias as defenses against unconscious conflicts rooted in the child's early upbringing. Behavioral and learning theories held that fear and anxieties were learned through classical conditioning. Attachment theory posits that fearfulness in children is biologically rooted in the emotional attachment needed for survival.
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What is temperament's role in anxiety disorders?
Behavioral inhibition is an enduring trait for some and a predisposing factor for social reticence and the development of later anxiety disorders, particularly SOC.
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What is the family and genetic risk for anxiety disorders?
Children tend to inherit general tendencies to be inhibited, tense, or fearful. Children of parents with anxiety disorders have an increased risk of having anxiety disorders.
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What are the neurobiological factors associated with anxiety?
Anxiety is associated with specific neurobiological processes, and vulnerability for anxiety is most likely localized to brain circuits involving the brain stem, the limbic system, the HPA axis, and the frontal cortex.
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What are the family factors associated with anxiety?
Anxiety is associated with a number of family factors, including specific parenting practices, family functioning, the parent-child attachment, and parents' beliefs about their children's anxious behavior.
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What are the primary problems that treatments for anxiety disorders target?
Treatments for anxiety disorders are directed at modifying four primary problems: distorted information processing, physiological reactions to perceived threat, sense of a lack of control, and excessive escape and avoidance behaviors.
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What is behavior therapy, and what are its main techniques?
The main technique of behavior therapy is exposure, usually gradual exposure. A second form is systematic desensitization, which includes teaching the child to relax, constructing an anxiety hierarchy, and presenting the anxiety-provoking stimuli sequentially while the child remains relaxed. Flooding is exposure carried out in prolonged and repeat doses.
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What is cognitive-behavioral therapy (CBT), and what does it teach?
CBT teaches youths to understand how thinking contributes to anxiety and how to modify their maladaptive thoughts to decrease their symptoms.
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What role do medications play in the treatment of anxiety disorders in children?
Medications such as SSRIs are effective in treating children with anxiety disorders. Medication is reserved for those with severe symptoms or comorbid disorders or when CBT is not available or proves unsuccessful.
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What is the significant link between childhood trauma and mental health consequences?
Considerable evidence supports the significant link between childhood trauma and immediate and long-term mental health consequences, leading some to call childhood trauma “the hidden epidemic”.
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What are traumatic events defined as?
Traumatic events are defined as exposure to actual or threatened harm or fear of death or injury and are considered uncommon or extreme stressors.
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What is child maltreatment?
Child maltreatment is a generic term that refers to four primary acts: physical abuse, neglect, sexual abuse, and psychological abuse.
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What are some paradoxical dilemmas that victims of child maltreatment may face?
Because children are dependent on the people who harm or neglect them, they face paradoxical dilemmas as well, such as the victim not only wanting to stop the violence but also longing to belong to a family, affection and attention may coexist with violence and abuse, and the intensity of the violence tends to increase over time, although in some cases physical violence may decrease or even stop altogether.
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What are the determinants of healthy parent-child relationships and family roles?
The determinants of healthy parent-child relationships and family roles include adequate knowledge of child development and expectations, adequate skill in coping with the stress related to caring for small children, opportunities to develop normal parent-child attachment and early patterns of communication, adequate parental knowledge of home management, opportunities and willingness to share the duties of child care between two parents, when applicable, and provision of necessary social and health services.
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What is an expectable environment?
An expectable environment is external conditions or surroundings that are considered to be fundamental and necessary for healthy development. For infants, it is protective and nurturing adults and opportunities for socialization. For older children, it includes a supportive family, contact with peers, and ample opportunities to explore and master the environment.
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What is the continuum of care when it comes to child care?
The continuum of care can be described along a hypothetical continuum ranging from healthy to abusive and neglectful.
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What is child maltreatment?
Child maltreatment is broadly defined as “any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm”.
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What is polyvictimization?
Polyvictimization is the experience of victimization across multiple domains of the child’s life.
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What are the types of neglect?
The types of neglect include physical neglect, educational neglect, and emotional neglect.
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What is physical abuse?
Physical abuse is multiple acts of aggression that include punching, beating, kicking, biting, burning, shaking, or otherwise physically harming a child.
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What is sexual abuse?
Sexual abuse includes fondling a child’s genitals, intercourse with the child, incest, rape, sodomy, exhibitionism, and commercial exploitation through prostitution or the production of pornographic materials.
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Who are the most common victims of abuse and neglect?
Younger children are the most common victims of abuse and neglect, while sexual abuse is more common among the older age groups.
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What are some causes of child trauma, stress, and maltreatment?
Many forms of child trauma, stress, and maltreatment are connected to poverty and inequality social isolation, and unhealthy cultural norms concerning child-rearing practices and family privacy.
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What are Trauma- and Stressor-Related Disorders?
Trauma- and Stressor-Related Disorders refer to a group of disorders that can occur following exposure to a traumatic or stressful event. These disorders include Reactive Attachment Disorder (RAD), Disinhibited Social Engagement Disorder (DSED), Acute Stress Disorder, Adjustment Disorder, and Post-traumatic Stress Disorder (PTSD).
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What is Reactive Attachment Disorder?
Reactive Attachment Disorder (RAD) is a disorder that is characterized by a pattern of disturbed and developmentally inappropriate attachment behaviours.
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What is Disinhibited Social Engagement Disorder?
Disinhibited social engagement disorder (DSED) is characterized by a pattern of overly familiar and culturally inappropriate behaviour with relative strangers, due to social neglect.
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What is the prevalence and age range for RAD and DSED?
RAD and DSED are only diagnosed in children between 9 months and 5 years.
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What is Post-traumatic Stress Disorder?
Post-traumatic Stress Disorder (PTSD) is a disorder that occurs when an individual displays persistent anxiety following exposure to or witnessing of an overwhelming traumatic or stressful event that is outside the range of usual human experience.
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What is the cycle of violence hypothesis?
The cycle of violence hypothesis is the repetition of patterns of violent behaviour across generations; it explains why persons who are abused as children are more likely to be abusive toward others as adults.
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What is Trauma-focused cognitive-behavioural therapy (TF-CBT)?
Trauma-focused cognitive-behavioural therapy (TF-CBT) is a form of exposure therapy that incorporates elements of cognitive-behavioural, attachment, humanistic, empowerment, and family therapy models. It is a treatment for PTSD that has been found to be effective for children.
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What is Complex Trauma?
Reactions to trauma that consist of more complex patterns extending beyond typical symptoms related to PTSD
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What are some treatments of Physical Abuse?
Treatment of physical abuse involves training parents in more positive child-rearing skills, accompanied by cognitive-behavioural methods to target specific anger patterns or distorted beliefs
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What are some treatments for Child Neglect?
Treatment for child neglect focuses on parenting skills and expectations, coupled with training in social competence and household management
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What is the history of the interrelationship between the mind and body?
The interrelationship between the mind and body has fascinated and perplexed various cultures since Greek philosophers first suggested that pain and disease were caused by an imbalance in the body's basic elements of fire, air, water, and earth. An early distinction emerged between disorders caused by physical factors and those caused by emotional or psychological factors. Physical disorders caused or affected by psychological and social factors were referred to as psychosomatic, later referred to as psychophysiological. For centuries, poorly understood physical symptoms have been misattributed to psychological causes. Today, pediatric health psychologists study how children's health-related problems interact with their psychological well-being and how they and their families adapt in response.
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What is the role of sleep in physical and mental health?
Sleep serves a fundamental role in brain development and regulation, and sleep disturbances can affect overall physical and mental health and well-being. The prefrontal cortex is an important executive control center in the brain responsible for processing emotional signals and making critical decisions for response. Impairment of the prefrontal cortex can result in signs of decreased concentration and diminished ability to inhibit, or control, basic drives, impulses, and emotions.
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What are dyssomnias and parasomnias?
Dyssomnias are disorders of initiating or maintaining sleep, characterized by difficulty getting enough sleep, not sleeping when you want to, not feeling refreshed after sleeping, and so forth. Many sleep problems resolve themselves as the child matures, especially if parents are given basic information and guidance. Dyssomnias are common, except for narcolepsy, which while uncommon poses an increased risk of cognitive and emotional problems including depression, anxiety, and low self-esteem. Breathing-related sleep disorders can affect children of various ages because of allergies, asthma, or swollen tonsils.
Parasomnias, in contrast, are sleep disorders in which behavioral or physiological events intrude on ongoing sleep. Parasomnias include nightmares (repeated awakenings, with frightening dreams that you usually remember), sleep terrors (abrupt awakening, accompanied by autonomic arousal but no recall), and sleepwalking (getting out of bed and walking around, with no recall the next day). Nightmares occur during REM sleep, while sleep terrors and sleepwalking occur during non-REM sleep. DSM-5 diagnostic criteria for all sleep-related disorders emphasize the presence of clinically significant distress or impairment in social, occupational, or other important areas of functioning and the requirement that the sleep disturbance cannot be better accounted for by another disorder, the direct physiological effects of a substance, or a general medical condition (other than a breathing-related disorder).
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What are some treatments for sleep disorders in children?
If going to sleep or staying asleep becomes difficult, parents are taught to attend to the child's need for comfort and reassurance but to gradually withdraw more quickly from the child's room after saying goodnight. Individualized bedtime rituals, establishing a positive transition to bedtime, and regular bedtimes/waking times establish a consistent sleep hygiene routine. Prolonged treatment is usually not necessary, particularly if the episodes of sleep intrusion occur infrequently. If sleepwalking is suspected, parents are asked to record episodes at home on video, and if confirmed, parents must take precautions to reduce the chance of injury to a child who may fall or bump into objects.
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What are some treatments for sleep disorders in children?
If going to sleep or staying asleep becomes difficult, parents are taught to attend to the child's need for comfort and reassurance but to gradually withdraw more quickly from the child's room after saying goodnight. Individualized bedtime rituals, establishing a positive transition to bedtime, and regular bedtimes/waking times establish a consistent sleep hygiene routine. Prolonged treatment is usually not necessary, particularly if the episodes of sleep intrusion occur infrequently. If sleepwalking is suspected, parents are asked to record episodes at home on video, and if confirmed, parents must take precautions to reduce the chance of injury to a child who may fall or bump into objects.
