Test 2

Question 1

Oppositional Defiant Disorder

Answer 1

Age-inappropriate recurrent pattern of stubborn, hostile, disobedient, and defiant behaviors
* Usually appears by the age of 8
* Severe ODD behaviors can have negative effects on parent-child interactions
* Also predict a variety of social and interpersonal difficulties in early adulthood

Question 2

Conduct Disorder

Answer 2

Repetitive, persistent pattern of severe aggressive and antisocial acts
− The DSM-5-TR groups symptoms of CD into four dimensions
 Aggression to people and animals
 Destruction of property
 Deceitfulness or theft
 Serious violations of rules

Question 3

ODD and CD connection

Answer 3

Nearly half of all children with CD have no prior ODD diagnosis
* Most children who display ODD do not progress to more severe CD
* For most children
− ODD is an extreme developmental variation
− ODD is a strong risk factor for later ODD
− ODD does not signal an escalation to more serious conduct problems

Question 4

Cognitive and Verbal deficits

Answer 4

Most children with conduct problems have average intelligence
* Verbal deficits are present in early development
* Deficits in executive functioning
− Co-occurring ADHD may be a factor
− Types of executive function exhibited may differ—cool versus hot executive functions

Question 5

School and Learning Problems

Answer 5

Children with conduct problems display many school difficulties
− Underachievement, grade retention, special education placement,
dropout, suspension, and expulsion
* It is likely that a common factor underlies both conduct problems and school difficulties
* Relationship between conduct problems and underachievement is firmly established by adolescence
− May lead to anxiety or depression in young adulthood

Question 6

Hostile attributional bias vs. reactive aggression

Answer 6

Reactive-aggressive children display hostile attributional bias(view world as negative and out to get them)
* Proactive-aggressive view their aggressive actions as positive

Question 7

Self Esteem/Health Issues

Answer 7

Many children with conduct problems have low self-esteem
− Research does not support low self-esteem as a primary cause of conduct problems
− Conduct problems seem to be more closely related to an inflated, unstable, and/or tentative view of self
* Young people with persistent conduct problems engage in many behaviors that place them at high risk for personal injuries
− Rates of premature death due to various causes are 3 to 4 times higher in boys with conduct problems

Question 8

Gender Differences in Conduct Problems

Answer 8

Gender differences are evident by 2 to 3 years of age
* During childhood, rates of conduct problems are about two to four times higher in boys
* Boys have earlier age of onset and greater persistence
− Early symptoms for boys are aggression and theft
− Early symptoms for girls are sexual misbehaviors
* Antisocial girls are more likely than others to develop relationships with antisocial boys

Question 9

Antisocial Personality Disorder (APD)
and Psychopathic Features in conduct disorder

Answer 9

Pervasive pattern of disregard for and violation of the rights of others
− As many as 40% of children with CD later develop APD
− Adolescents with APD may display psychopathic features
− Signs of lack of conscience occur as young as 3 to 5 years old
* Subgroup of children with CD
− At risk for extreme antisocial and aggressive acts
− Display callous and unemotional (CU) interpersonal style
− Lack guilt and empathy; do not show emotions; display narcissism and impulsivity; and lack behavioral inhibition

Question 10

Life-course persistent path

Answer 10

begins early and persists into adulthood
 Antisocial behavior begins early
 Subtle neuropsychological deficits heighten vulnerability to antisocial elements in social environment

Question 11

adolescent limited path

Answer 11

begins at puberty and ends in
young adulthood
 Less-extreme antisocial behavior
 Delinquent activity is often related to temporary situational factors

Question 12

Treatments for CD and ODD

Answer 12

Most promising treatments use a combination of approaches that are applied across individual, family, school, and community settings
− Parent Management Training (PMT): focus is on improving parent–child interactions and enhancing other parenting skills
− Problem-Solving Skills Training (PSST): focuses on the cognitive deficiencies and distortions
− Multisystemic Therapy (MST): seeks to empower caregivers to improve youth and family functioning

Question 13

Parent-Management Training

Answer 13

Teaches parents to change their child’s behavior in the home and in
other settings using contingency management techniques. The focus is
on improving parent-child interactions and enhancing other parenting
skills (e.g., parent-child communication, monitoring, and supervision)`

Question 14

Problem Solving Skills Training

Answer 14

Identifies the child’s cognitive deficiencies and distortions in social situations and provides instruction, practice, and feedback to teach new ways of handling social situations. The child learns to appraise the situation, change his or her attributions about other children’s
motivations, be more sensitive to how other children feel, and generate alternative and more appropriate solutions

Question 15

Multisystemic Therapy

Answer 15

An intensive approach that draws on other techniques such as PMT, PSST, and marital therapy, as well as specialized interventions such as special education, and referral to substance abuse treatment programs or legal services.

Question 16

Depression

Answer 16

A pervasive unhappy mood disorder
− More severe than the occasional blues or mood swings everyone experiences
* Children who are depressed cannot shake their sadness
− Interferes with their daily routines, social relationships, school
performance, and overall functioning
− Often accompanied by anxiety or conduct disorders
− Often goes unrecognized and untreated

Question 17

Depression in young people

Answer 17

Almost all young people experience some symptoms of depression
− Many experience significant depression at some time
− Is displayed as a lasting depressed mood with disturbances in
 Thinking
 Physical functioning
 Social behavior
* Suicide among teens is a serious concern
* 90% of youth with depression show impairment in daily functions

Question 18

Major Depressive Disorder

Answer 18

Diagnosis in children
− Same criteria for school-age children and adolescents
− Depression is easily overlooked because other behaviors attract more attention
− Some features (e.g., irritable mood) are more common in children and adolescents than in adults
− Diagnosis of MDD depends on the presence of a major depressive episode plus the exclusion of other conditions

Question 19

Comorbidity of Depression

Answer 19

As many as 90% of young people with depression have one or more other disorders; 50% have two or more
* Most common comorbid disorders include
− Anxiety disorders (especially GAD), specific phobias, and separation anxiety disorders
* Other common comorbid disorders are
− Persistent depressive disorder (P-DD), conduct problems, ADHD, and substance-use disorder

Question 20

Persistent Depressive Disorder

Answer 20

Is characterized by symptoms of depressed mood that occur on most days, and persist for at least one year
* Child with P-DD also displays at least two somatic or cognitive symptoms
* Symptoms are less severe, but more chronic than those of MDD
* Poor emotion regulation
* Children with both MDD and P-DD (double depression)
− More severely impaired than children with just one disorder

Question 21

Disruptive Mood Dysregulation Disorder

Answer 21

The central feature of disruptive mood dysregulation disorder(DMDD) is chronic, severe
persistent irritability
* Two main clinical features
− Frequent verbal or physical temper outbursts
− Chronic, persistently irritable or angry mood
* Occurs predominantly in males and in school age children
* Has high comorbidity with anxiety, mood, and disruptive behavior disorders
* Markedly disrupts the youth’s family

Question 22

Psychodynamic Theory of Depression

Answer 22

Depression is viewed as the conversion of aggressive instinct into depressive affect
− Results from the actual or symbolic loss of a love object
* Children and adolescents are believed to have inadequate development of the superego or conscience
− Therefore, they do not become depressed
* High levels of maladaptive guilt and shame are related to the onset of depression

Question 23

Attachment theory of depression

Answer 23

Focuses on parental separation and disruption of an attachment bond as predisposing factors for depression
* Parent’s consistent failure to meet the child’s needs is associated with
− The development of an insecure attachment
− A view of the self as unworthy and unloved
− A view of others as threatening or undependable
* These factors may place the child at risk for later depression

Question 24

Behavioral theory of depression

Answer 24

emphasize the importance of learning and
environmental consequences
− Depression is related to a lack of response-contingent positive reinforcement

Question 25

Cognitive theory of depression

Answer 25

focus on relationship between negative thinking and mood
− Emphasize depressogenic cognitions
− Hopelessness theory
 Information-processing biases, or errors in their thinking in specific situations, called negative automatic thoughts
 Negative view about oneself, the world, and the future (negative cognitive triad)

Question 26

Bipolar Disorder

Answer 26

A striking period of unusually and persistently elevated, expansive, or irritable mood, accompanied by increased goal-
directed activity or energy
− Alternating with or accompanied by one or more major depressive episodes
− Elation and euphoria can quickly change to anger and hostility if behavior is impeded
 May be experienced simultaneously with depression

Question 27

Bipolar symptoms in young children

Answer 27

BP in young people is difficult to identify because
− It occurs infrequently
− Shows extreme variability of clinical presentation
− Overlaps in symptoms with more common childhood disorders
* Young people with BP display
− Significant impairment in functioning, including previous hospitalization, MDD, medication treatment, co-occurring disruptive behavior, and anxiety disorders
− History of psychotic symptoms and suicidal ideation/attempts are common

Question 28

Bipolar Disorder Symptoms

Answer 28

Restlessness, agitation, and sleeplessness
− Pressured speech, flight of ideas, and racing thoughts
− Sexual disinhibition, surges of energy, and expansive grandiose beliefs
* Three subtypes
− Bipolar I disorder
− Bipolar II disorder
− Cyclothymic disorder

Question 29

Causes of Bipolar Disorder

Answer 29

BP is one of the most heritable forms of mental disorder
* Family and gene studies indicate that BP is the result of a genetic vulnerability combined with environmental factors
* Nonspecific risk factors that raise the risk for BP include
− Poor maternal health or nutrition during pregnancy
− Substance use during pregnancy
− A stressful early environment and exposure to traumatic events
− Parental mood disorders

Question 30

Other causes of Bipolar Disorder

Answer 30

Multiple genes may be involved
− Genetic predisposition does not necessarily mean a person will develop BP
* Brain-imaging studies suggest mood fluctuations are related to irregularities in areas of the brain related to:
− Emotion regulation prefrontal and anterior cingulate cortex, hippocampus, amygdala, thalamus, and basal ganglia

Question 31

Treatment for Bipolar Disorder

Answer 31

There is no cure for BP
* A multimodal plan includes
− Monitoring symptoms closely
− Educating the patient and the family
− Matching treatments to individuals
− Administering medication, for example, lithium
− Addressing symptoms and related psychosocial impairments with psychotherapeutic interventions

Question 32

Psychosocial Treatmeants for Bipolar Disorder

Answer 32

Providing information to the child and family about the disorder, symptoms and course, possible impact
− Family functioning, and heritability of the disorder
− Positive family relationships can protect against the impact of genetic vulnerability
− Ways of coping with symptoms and preventing relapse
 Problem-solving
 Behavioral parenting strategies and communication
 Emotion regulation, and cognitive–behavioral skills

Question 33

Rates of BP Diagnosis

Answer 33

Lifetime estimates of BP range from 0.5% to 2.5% of youths 7 to 21 years old
− It is difficult to make an accurate diagnosis
* In youngsters, milder bipolar II and cyclothymic disorder are more likely than bipolar I
− Rapid cycling episodes are common
* Extremely rare in young children
− Rate increases (nearly as high as that for adults) after puberty
About 60% of patients with BP have a first episode prior to age 19

Question 34

Separation Anxiety Disorder

Answer 34

− It is normal from about age 7 months through preschool years
− Lack of separation anxiety at this age may suggest insecure attachment
* SAD is distinguished by
− Age-inappropriate, excessive, and disabling anxiety about being apart from parents or away from home
− Over time children with SAD may become increasingly withdrawn, apathetic, and depressed

Question 35

Specific Phobia

Answer 35

Age-inappropriate persistent, irrational, or exaggerated fear that leads to avoidance of the feared object or event and causes impairment in normal routine
− Lasts at least six months
− Extreme and disabling fear of objects or situations that in reality pose little or no danger or threat
− Child goes to great lengths to avoid the object/situation
* Fear or anxiety may be expressed by crying, tantrums, freezing, or clinging

Question 36

Social Anxiety Disorder

Answer 36

A marked, persistent fear of social or performance requirements that expose the child to scrutiny and possible embarrassment
− Anxiety over mundane activities
− Most common fear is doing something in front of others
− More likely than other children to be highly emotional, socially fearful; and inhibited, sad, and lonely
* Social anxiety disorder encompasses a variety of social fears
− Fear of performance situations
− Fear of interaction situations

Question 37

Selective Mutism

Answer 37

Failure to talk in specific social situations, even though they may speak loudly and frequently at home or other settings
* Estimated to occur in 0.7% of children
* Average age of onset is 3 to 4 years
* Selective mutism may be a developmentally specific variant of social anxiety disorder in young children
* May be an extreme type of social phobia, but there are differences between the two disorders

Question 38

Panic Disorder

Answer 38

recurrent unexpected panic attacks
− At least 1 month of persistent concern or worry about having another attack and its consequences
− Significant change in behavior related to the attacks in order to avoid having them

Question 39

Agoraphobia

Answer 39

marked fear or anxiety in certain places or
situations

Question 40

Generalized Anxiety Disorder

Answer 40

Excessive, uncontrollable anxiety and worry
− Worrying can be episodic or almost continuous
− Worry excessively about minor everyday occurrences
* Accompanied by at least one somatic symptom, such as:
− Headaches, stomach aches, muscle tension, and trembling

Question 41

Obsessive-Compulsive Disorder

Answer 41

an unusual disorder of ritual and doubt
− Characterized by recurrent, time-consuming, and disturbing obsessions and compulsions
 Obsessions: persistent and intrusive thoughts, urges, or images
 Compulsions: repetitive, purposeful, and intentional behaviors or mental acts performed to relieve anxiety
* OCD is extremely resistant to reason
* OCD children often involve family members in rituals
* Normal activities of children with OCD are reduced, and health, social and family relations, and school functioning can be severely disrupted

Question 42

common compulsions

Answer 42

excessive washing and bathing (occurring in about 85% of cases), repeating, checking, touching, counting, hoarding, and ordering or arranging

Question 43

CBT for Anxiety Disorder

Answer 43

The most effective procedure for treating most anxiety disorders
* Almost always used with exposure-based treatments
* Coping Cat: decrease negative thinking, increase active problem solving, and a functional coping outlook
* Skills training and exposure combat problematic thinking
* Computer-based CBT has also been shown to be effective

Question 44

Behavior Therapy for Anxiety Disorders

Answer 44

Main technique is exposure to feared stimulus
− While providing children with ways of coping other than escape and avoidance
* Systematic desensitization
* Flooding: prolonged repeated exposure
* Response prevention prevents child from engaging in escaping or avoidance stimuli
* Modeling and reinforced practice

Question 45

Family Interventions for Anxiety Disorder

Answer 45

Child-focused treatments may have spillover effects into the family
* Greater parental involvement
− Modeling and reinforcing coping techniques
− Inclusion of parental anxiety-management strategies
− Inclusion of parent skills training
* Family treatment for OCD
− Provides education about the disorder
− Helps families cope with their feelings

Question 46

Medications for Anxiety Disorders

Answer 46

Medications can reduce symptoms, especially for OCD
− The most common and effective medications are selective serotonin reuptake inhibitors (SSRIs), especially for OCD
* Medications are most effective when combined with CBT
* CBT is the first line of treatment

Question 47

Traumatic Events

Answer 47

exposure to actual or threatened harm or
fear of death or injury and are considered uncommon or extreme stressors
Trauma and stressful experiences in childhood or adolescence may involve
− Actual or threatened death
− Injury
− A threat to one’s physical integrity

Question 48

Physical Abuse

Answer 48

multiple acts of aggression
− In most cases, the injuries from physical abuse may not be intentional
− Occur as a result of over-discipline or severe physical punishment

Question 49

Sexual Abuse

Answer 49

Fondling a child’s genitals
− Intercourse with the child, incest, rape, and sodomy
− Exhibitionism, and commercial exploitation through prostitution or the production of pornographic materials
* May significantly affect behavior, development, and physical health of sexually abused children
* Many exploited children began as victims of abuse and rape in their homes

Question 50

Reactive Attachment Disorder

Answer 50

characterized by a pattern of disturbed and developmentally inappropriate attachment behaviors
− Children with RAD
 Show no consistent effort to seek comfort or nurturance from their caregiver
 Fail to respond to their caregiver’s efforts to comfort them
 Seldom express positive emotion when interacting with their caregivers
 Emotion regulation is compromised

Question 51

Disinhibited Social Engagement Disorder

Answer 51

Shows a pattern of overly familiar and culturally inappropriate behavior with relative strangers
− Fail to check with caregivers and may venture away
− Exhibit intrusive and overly familiar behavior with strangers
− Have experienced extremes of insufficient care
* Such behavior can be dangerous, especially since the child may be willing to walk away with a stranger

Question 52

Treatment for RAD and DSED

Answer 52

Both RAD and DSED stem from very inadequate basic care early in development
* It is unknown what factors might cause one neglected child to become reticent and unresponsive to adults, while another becomes disinhibited and indiscriminate in seeking adult
attention
* Interventions that focus on improving caregiving quality (e.g., stability, positive affection, and safety) are warranted

Question 53

Post-Traumatic Stress Disorder

Answer 53

development during or after exposure to an extreme traumatic stressor
* PTSD for children (over age 6) as well as adults involves four core features that persist longer than 1 month
− Symptoms of intrusion and avoidance of distressing thoughts
− Distortions in thoughts or feelings and extreme arousal and reactivity
* Some symptoms are expressed differently in children than in adults
− Nightmares instead of flashbacks
(Acute stress disorder occurs in less than a month)

Question 54

allostatic load

Answer 54

progressive wear and tear on biological systems
due to chronic stress

Question 55

mood and affect disturbances for trauma

Answer 55

Symptoms of depression, emotional distress, and suicidal ideation are common among children with histories of physical, emotional, and sexual abuse
* Teens with histories of maltreatment have a much greater risk of substance abuse
* Childhood sexual abuse also can lead to eating disorders, such as anorexia nervosa and bulimia nervosa
* Children or adults may induce an altered state of consciousness known as dissociation

Question 56

Onset for Conduct Disorder

Answer 56

Childhood-onset conduct disorder: display symptoms of the disorder before the age of 10
− Adolescent-onset conduct disorder: no symptoms before the age of 10

Question 57

Depression During young ages

Answer 57

• Preschoolers: may appear extremely somber and tearful
  − Lacking exuberance; may display excessive clinging and whiny
• School-age children: many of the symptoms of preschoolers
  − Plus, increasing irritability, disruptive behavior, and tantrums
• Preadolescents and adolescents: similar symptoms of younger children
  − Plus, self-blame, low self-esteem, persistent sadness, and social inhibition

Question 58

Psychosocial Intervention for Depression

Answer 58

Primary and Secondary Control Enhancement Training (PASCET)
− Primary control skills (ACT skills)
− Secondary control skills
* The ACTION Program
* Adolescent Coping with Depression Program (CWD-A)
* Interpersonal Psychotherapy for Adolescent Depression (IPT-A)