Module 4: Child, adolescent and eating disorders Flashcards
What does the DSM-5 focus on child related disorders?
DSM-5-TR childhood disorders focus on externalising disorder, eg. ODD, CD and ADHD
What is the prevalence of mental health disorders in children?
1/7 people aged 4-17 years old,
males more likely than females, anxiety is more prevalent than MDD, ADHD are more common than CD
How does disorder onset align with lifespan time and development?
Example: ADHD occurs around primary school where children are placed in more strict and demanding environments such as school, eating disorders and social anxiety occur around adolescence when the body starts to change and more stressors on social functioning
What is the Developmental Psychopathology (DP) Framework?
Developmental approach to understanding maladaptive childhood behaviours
- integrating the aetiology, treatment and outcome of disorders
- biopsychosocial factors
- development as a continuous process compared to distinct stages of development, eg. Piaget
What are the Developmental Psychology Framework Principles?
- Atypical development
- Equifinality
- Multifinality
- Risk /protective factors
- Adaptation and resilience
What is atypical development and what does it have to consider?
- comparing against typical development to determine what is problematic while also considering:
- Children develop skills at different times
- Culture influences expectations about a child’s development and shapes cognition, emotional and linguistic development and overall socialisation
What is equfinality?
- suggests that many different factors or developmental pathways contribute towards a disorder, eg. harsh parenting, ambivalent attachment
basically early experiences & risk factors (predictors) can lead to the SAME/SIMILAR outcome or disorder
What is Multifinality?
- theory that the SAME/SIMILAR early experiences or risk factors can lead to DIFFERENT outcomes or disorders, eg. abuse could turn into aggression, resilience or anxiety
What is Adaptation and resilience?
factors that promote these concepts help explain why some individual thrive after trauma/stress exposure and others
What are some DSM-5-TR child/adolescent related disorders?
- Neurodevelopmental disorders, ASD, SLD, IDD, ADHD
- Disruptive, impulse control and conduct disorders
- Feeding and eating disorders
- Mood and anxiety disorders
What’s the dimensional approach to child/adolescent related disorders?
- Considers childhood/adolescent disorders along a spectrum from INTERNALISING to EXTERNALISING
What are 3 externalising disorders?
(under-controlled behaviour):
ODD, CD & ADHD
How does presentation of conduct disorder show across childhood/adolescence?
3-6 years= noncompliance, argumentative, tantrums, irritability
7-10 years = lies, physical fights, manipulation, bullying, animal cruelty
11-14 years = stealing assault, not respective, truancy, running away
What are the 2 child-related conduct disorders and what are the differences between them?
- Oppositional defiant disorder - - persistent pattern of violence/hostility
1st dimension: angry, irritable mood,
2nd dimension: argumentative and defiant behaviour
3rd dimension: vindictiveness / a strong desire to get back at someone
Conduct disorder (CD) - violation of people’s rights and social norms
Aggression, property destruction, theft and violation of rules
What’s the typical developmental trajectory of ODD and CD?
ODD is often diagnosed beforehand at a younger age, before a person may develop conduct disorder
How does the prevalence of antisocial behaviour change
- Adolescent onset peak in adolescent and gradually fade
- The hardest and most persistent are cases with an EARLY ONSET and PERSISTENT nature
- Early onset are of higher risk of criminal convictions into adulthood
What 3 aspects of temperament can maintain ODD/CD disorders in children?
1) High emotional reactivity
2) Low effortful control
3) Callous unemotional personality
What 3 aspects of neuropsychology can maintain ODD/CD disorders in children?
1) Low IQ
2) Learning problems
3) Executive dysfunction
What 2 aspects of emotion can maintain ODD/CD disorders in children?
1) Dysregulated affect: difficulty regulating negative emotions, eg. anger and sadness
2) Emotion recognition bias or deficit
What 2 aspects of cognition can maintain ODD/CD disorders in children?
1) Dysfunctional social cognition: do attributing something neutral as intentional/harmful/malicious and reacting accordingly
2) Low self esteem
What behaviours are representative of the Callous-Unemotional (CU) personality?
- Lack of remorse or guilt = they may feel remorse for getting caught but not feeling any remorse for how their behaviours for impacted others
- Callous lack of empathy = unconcerned with other people’s distress
- Shallow or deficient affect = not being able to switch on/off
- Unconcerned about performance = in school, activities
What are the two major factors in a family that can maintain and risk ODD and CD?
- Parenting styles - that lacks discipline, harsh or neglectful parenting, lack of positive or warmth in parenting, insecure attachment styles, poor communication or monitoring of child
Family stressors - trauma, abuse, stress exposure, parental incarceration or having mental health problems
What is the Parent-child-coercive cycle?
- creating reinforcing cycles of what each person expects from the other person
- example of family risk factor
What is the negative reinforcement loop?
Child’s eventual compliance negatively reinforces parent’s angry/intimidating behaviour,
“if i yell at them they will stop”
parent’s calmer state negatively reinforces child’s surrendering and vice versa if parents surrenders
What are social risk and maintaining factors of OCD and CD?
- School = problems with teachers, bullying, poor academic results
- Peers = peer rejection by non deviant peers, being with deviant peers, risky sexual behaviour
- Community = exposure to violence, poverty or discrimination
ADHA criteria requirements?
Need at least 6 criteria in inattention and 6 criteria hyperactivity/impulsivity domains
Observations of intrinsic vs. extrinsic motivation in people with ADHD?
Some parents describe child’s ability to stay focused on computer games but not school- but computer games
are often INTRINSICALLY MOTIVATED but struggle with behaviours that are more EXTRINSICALLY MOTIVATED
What delays of executive functioning in the frontal lobe do people with ADHD have?
- concentration
- inner speech
- working memory
- Organisation
- Emotional regulation
- Reward control and delayed gratification
What’s the comorbidity rate with ADHD?
60-70% of people with ADHD have other disorders like CD, ODD, anxiety, depression, learning disorders
What does Conduct problems management aim to achieve?
Parents as a point of intervention for the disorder and modifying the environment and trying to end cycles of negative reinforcement
Parent management training (PMT) is most common treatment for early conduct problems
Ineffective parenting and strategies maintains conduct problems in children
What are ineffective strategies for controlling difficult behaviour?
- Criticism trap “why can’t you just listen?” “why aren’t you just like your brother” = solution to ignore to decrease behaviours
- When the parent doesn’t pay attention to their child’s positive behaviours due to fatigue from the child’s negative behaviours
What are some common fears in children across their development?
Infants - parental separation, strangers, loud noises, large objects
2-6 years - parental separation, strangers, dogs, large animals, the dark, sleeping alone
7-11 years - home alone, bad things happening to self or others, injury, death, the dark, negative evaluation from school or peers
Teenagers - bad things happening to self or others, school issues, personal future, negative evaluation, natural disasters
What are the 3 core features of childhood anxiety?
- Anticipation of threat
- Physical complaints = somatic symptoms of stomach pain, increased heart rate
- Avoidance = maintains the anxiety
What is separation anxiety disorder and how does it present?
- inappropriate fear from being separated from the parent and a fear that the parent will die, fall sick or get kidnapped
- refuses to leave parent
dreams or nightmares, physical symptoms when anticipating separation like dizziness and stomach aches
What is Social Phobia and how does it present?
- fear of being negatively evaluated by other people, leading to avoidance of social interactions or performance
- Avoiding talking to teachers, fears of dating, performing, limited eye contact
How does GAD present in children?
Worry about family, school, minor everyday issues, friendships
Always seeking reassurance from parents “will it be ok? Will I be ok?”, sleeplessness
What is “formulation” in a clinical setting?
collecting pieces of information about person and person’s family to get an understanding of what is going on
What are the 5 ‘P’s Framework
- Presenting problem = summary about patient’s issues and observations
- Predisposing factors = things that have happened could influence the disorder
- Precipitating factors = is there a triggering event that made them seek help now?
- Perpetuating factors = things that maintain the disorder over time
- Protective factors = strengths of client, things that lower adverse mental health
What are the 6 components of CBT child-related therapy?
- Psychoeducation
- Behavioural activation
- In vivo or imaginal exposure
- Cognitive restructuring
- Parent training
- Social skills, assertiveness
What is negative body image and how does it relate to body dissatisfaction?
- Negative body image = distorted perception of one’s shape and feelings of shame, anxiety and self-consciousness (Stice, 2002)
- Body dissatisfaction = negative views of oneself + discrepancy between assessment of actual body and ideal body, often trying to achieve unrealistic goals
What’s the statistics on body image concerns and dissatisfaction?
- 81.1% of women are dissatisfied with their body weight, 2016
- 50% of adolescent girls are unhappy with their bodies
- 50% girls and ⅓ of teenage boys use unhealthy weight control behaviours, as young as 6 years old
What are the two main risk factors for eating disorders?
- Body dissatisfaction is the best known contributor to the development of anorexia nervosa and bulimia nervosa
increase likelihood for depression, low self-esteem, anxiety
- Dieting and dietary restriction is a core risk factor for the development or worsening of eating disordered behaviours
- encourages restrictive eating, weight loss and is connected with the western beauty ideal
What’s the definition of an ED?
ED is persistent disturbance of eating or eating related behaviour that results in the altered consumption or absolution of food and impairs physical health and psychosocial functioning
Prevalence of eating disorders?
Lifetime prevalence - 9%, 1/7 have disordered eating
AN has 10-20% of mortality rate
10th leading cause in non fatal disease burden for females aged 15-44
Only ¼ with an ED seek treatment
What demographic factors increase risk of EDs?
- higher for women, LP = 15% in women, 63% ED are female,
- LGBTQIIA+ have higher risk and prevalence of EDs, 23% of transgender have either had or have an ED
- Average age of onset = 12-25 years
What are the 3 diagnostic criteria for anorexia?
A. Restriction of energy intake to requirements - leading to significantly low body weight in context of one’s age sex , health and development, less than minimally normal for adults and minimally expected for child/adolescents, BMI<18.5
B. Intense fear of gaining weight or of becoming fact, or persistent behaviour that interferes with weight gain, even though a significantly low weight
C Disturbance in the way in which one’s body weight or shape in experienced, undue influence of body weight or shape on self-evaluation or persistent lack of recognition of the seriousness of the current low body weight
What are the 2 subtypes of anorexia nervosa?
Restricting type –
Weight loss is achieved primarily by dieting, fasting and/or excessive exercise, NO binging/purging
Binge-Eating / Purging type –
repetitive episodes of binge eating AND/OR purging behaviours over 3 months
prolonged restriction often set off the binge eating and purging cycle
Why are eating disorders harder to treat than other disorders?
EDs are ego-syntonic disorders
which means that the self-image of the person (wanting to be thinner) and aspirations is actually in line with their symptoms and behaviours, they often have less inclination to stop or seek help
(differs from ego-dystonic disorders with other disorders like anxiety, where the anxious individual does wants to get rid of their symptoms)
HARDER TO TREAT since the symptoms are already in line with what the individual wants / reduces help-seeking
Anorexia Nervosa prevalence rate?
LP = 0.9%, females 0.3-1.5%, males 0.1-0.5%,
10 : 1 RATIO = females to males
Age of onset = 14-18 but is decreasing in younger generations
Whats 3 potential reasons for such low male ED rates?
1) underreporting
2) ED stigma for men that doesn’t exist for women
3) diagnostic criteria being more closely aligned with female restricting behaviours towards thinness rather than male restricting behaviours towards slimness and muscular strength
What’s the comorbidity of AN with BN and other disorders?
High comorbidity with BN = 25%
60% with other psychiatric disorders
What are the health implications of anorexia?
MILD
Anaemia iron deficiency
Low metabolic rate
fluid/electrolyte imbalance
Dehydration
Lanugo - growth of fine hair layer
Compromised immune system
Hair falls out
Constant feeling of being cold
Gastrointestinal problems
BAD
Disturbance or cessation of menstruation
Increased risk of fertility issues in both genders
Osteoporosis - fragile bones
Heart problems
death/kidney failure
Yellowing of skin
What’s the mortality rate and treatment/relapse rate of anorexia nervosa?
Anorexia mortality rate ranges from 5-20% - dying from this disorder
25% of recovered individuals relapse after treatment, 20% remain chronically ill
60% of deaths are from sudden cardiac arrest, organ failure or suicide
Anorexia patients have a 31x risk of dying by suicide
