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Rutgers University Atypical Child and Adolescent Development Study Guide – Exam II 2016 Be familiar with the following terms, disorders and concepts. Chapter 6 – Protective Factors and Issues of Prevention Protective factors: be able to differentiate the following factors. o Resilience: a process by which children overcome adverse circumstance and develop into healthy and competent young adults, a pattern of positive adaptation in the context of past or present adversity, a dynamic concept o The infant or child how and if they are able to adapt positively in an environment with many challenges o Temperament: (genetics) an infant’s individual style in relation to the frequency of expression of needs and emotions, emotional regulation (ability to self-sooth), self-regulation has been associated with better outcomes in children raised in poverty (wide variety of temperaments) predisposition that child is born with to cope/channel their emotions; how often they display their emotions o Coping style: appraisal of a situation has; they make an automatic assessment of what is going on A child that is more intelligent make a better assessment of what is going on, they see the other parts that are going on o Cognitive abilities: your intelligence; high verbal ability (of children of mothers with depression was associated with decreased risk of depressive symptoms), more creative and effective in solving problems, most studied associate positive outcomes with at least average intelligence, bringing information from previous tasks to help with current tasks o Self-esteem: not born with it, changes overtime, can be high in childhood but decreases in adolescence, particularly with girls, sharp decline in the elderly, considered to be a buffer in children living in adverse environments o Self-efficacy: our belief in how well we can maneuver through tasks, children who come to believe success and that they will perform well, will try harder and stay engaged in the task at hand longer, child with high self-efficacy have more positive outcomes if from home where there are many challenges Self-efficacy is higher if they feel like they can go through challenges easier What are the characteristics within the family that prevent the likelihood of psychopathology with children/adolescents? o Close relationships with responsive caregiver o Positive relationship with competent siblings o Positive connections with extended family o Stable close relationship with at least one parent caregiver consistently shown to protect children from adverse circumstances o Authoritative parenting- results in more friendly independent, cooperative, socially responsible and academically advanced children o Father image is also important- when mom is not there dad is to help out What are the characteristics within the community that prevent the likelihood of psychopathology with children/adolescents? o Role models: teachers, coached, friends, peer tutors, religious leaders, siblings, close friends (people who can take place of parent) o High quality neighbors o Effective schools o Volunteerism o Make sure there are programs to keep children safe What are the characteristics within the culture or society that prevent the likelihood of psychopathology with children/adolescents? o Protective factors: community that values education, that has protective child policies, prevention and protection from political violence, low acceptance of physical violence o Ideally to have a value of education to the community o Protective measures to protect the children of society o Want the society to have no acceptance of any kind of violence o Prevalence rate of what is going on in the society Protective Factors: characteristics within the individual child, family or community that serve to decrease the likelihood of a child developing psychopathology in the face of adversity Chapter 7 - Depressive Disorders, Bipolar Disorders, and Related Problems Mood disorders: disturbance in emotion eg sadness, happiness, anger or hostility Symptoms of major depression o DSM-V o Depressed mood, or irritability in children (not being able to vocalize how they feel, they don’t know why they feel the way they go, may think it is normal, may not display depressive motives) Period time of at least 2 weeks o diminished interest or pleasure in activities once enjoyed (specifically in adolescents) had an interest in sports and suddenly no interest o significant weight loss or weight gain (adolescence), not meeting their mile stones for weight in children o insomnia or hypersomnia (sleep all the time but are still groggy when they get up) o fatigue or loss of energy nearly every day o feelings of worthlessness or excessive or inappropriate guilt o diminished ability to think, concentrate, or indecisiveness o recurrent thoughts of death o also physical symptoms o doesn’t need to have all the symptoms- about 5 is good How depression manifests in mood, behavior, and cognition o Mood- how we feel Irritability, feeling depressed, unable to feel happy At least 2 weeks Can’t see subjective o Behavior- what you see-what clinical depression is Forget about their hygiene (don’t take showers, don’t change clothes) Isolation- especially with teenagers can be dangerous Rather be by themselves o Cognition Find out there is an issue when they are not able to get a correct response, takes long to answer an answer you ask them, give them a clue Memory tasks to see where it is at Masked depression: historical picture o Children who are upset or act out can be depressed but it is not always true o Powerlessness, hopelessness nothing I can do and leads to depression o Acting out can lead to depression Depression in terms of gender o Boys and girls (0-11 age) are equal in terms of depression o Once you get into adolescence, twice as common to see in girls than boys because more acceptable to see girls expressing their emotions and boys dealing with it Go over in their head what they did wrong all the time (girls), while on the other hand boys get distracted Boy watched a bunch of movies and helped him get over depression Sometimes use different approaches (alcohol, drugs) Persistent Depressive Disorder (formerly known as Dysthymia) – How is it different then Major Depression? o Persistent depressive- far more chronic than major depression, lasts months on end, but the difference is symptoms are not as severe (they are still the same symptoms though)- still able to function Medication can help boost their feelings You can develop PDD now (all of the sudden not happy about things, don’t feel good, but you remember when you got excited about things) Therapy can help too How is early onset PDD different from PDD which may begin later in adolescence? Early onset- your brain is malleable but is being effected make it a chronic course and is medicine resistant (basically going to have to live with it the rest of your life) Double Depression- get depression early on and then all of the sudden gets worse and have the feelings all the time o Having both PDD and major depression What specific problems can develop with regard to academics, peers, and family which could exacerbate the depression in a child/adolescent? o If you are depressed as a child or adolescent you have no interest in academics, they are not as good as they used to be o No interest to be around people o Peer-relationship: they eventually pull back, once friend gives up feels like self-fulfilling prophecy, become more depressed Similar to family but they are more angry (but child cannot help it, it is all chemical) o Siblings can be very resentful because descions made negatively effect them (can’t go on vacation because sibling is depressed) What are the main theories for the development of depression from the following perspectives: Psychodynamic, Attachment, and Behavioral, Cognitive behavioral? o Psychodynamic- child has lost the love object (can be anything they feel is very important to them- family moving, difficulty making new friends, family member) Also is parents are highly critical or punishing of child, child begins to think that there is something wrong with them that makes their parents dislike them (they know they can’t retaliate against parents so they retaliate against themselves- anger inward) o Attachment- avoidant or resistance They learn that this is their world and if mom and dad cannot be trusted to be consistent or is very punitive, this is what they begin to feel about the world Go into school environment with the same feelings: parents are like this and can’t trust them so why should I trust anyone else o Behavioral o All about rewards and punishments o Child became depressed because he/she hasn’t had enough rewards for doing things correctly o You try to please your parents but they don’t seem to care and because of this you become to feel depressed o Cognitive o The way we look at the world at large o Similar to Becks Cognitive Theory of Depression o How we view the future o People who are clinically depressed (biology based) view everything as if they were wearing shades (everything is dark), negative about themselves and their ability to do anything o Because of that they look at the world and only see darkness o As well as their future seems bleak o This is a biological component o These thoughts become a life force Beck’s Cognitive Theory of Depression o Thoughts effect mood which effects behavior o View of Self, View of World/experiences, View of Future Diathesis Stress Model- genetic, predisposition for depression or any other disorder o Its there with the person but doesn’t come out until there is a big stressor that comes into their lives o They could go their entire life having the predisposition but never becoming depressed unless something happens according to this model o Personal vulnerability and life stressors o Autonomic activity o Reward sensitivity o Amygdala, hippocampus (limbic system) o Prefrontal cortex Brain structures implicated in depression o Amygdala: processes very strong emotions (how you felt during 9/11) Memories that have had a big impact Include anger and fear Diminished in size compared to normal individuals o Thalamus: a shaped, relay station, all information coming through environment comes to the thalamus Suppose to send information to different part of the brain- if there is a problem with it it doesn’t send to other parts of the brain o Hippocampus: works together with the amygdala Processes short term memory into long term memory Helps with the amygdala and strong emotions connects it with the memory o Prefrontal Cortex: what is important for attention and what isn’t With depression you focus on things that don’t usually matter Bipolar I, Bipolar II, Cyclothymia, Rapid cycling o In the past, BP was only recognized as an adult disorder and did not appear in childhood or adolescence o Currently, BP is diagnosed in adolescence after puberty but rarely occurs in early childhood o Bipolar I (Mania with depression) Most severe of the bipolar disorders Flight of ideas Distractibility Grandiosity Increased goal activity Excessive involvement in pleasurable activities with potential for painful consequences Intense irritability Decreased sleep Have the two poles (opposite ends) Pole 1: mania – very severe actions, and then fluctuate to pole 2: depression Mania- grandiose thinking (jump of building and fly, can come up with something that will cure HIV), judgment is severely impaired, pressured speech (trying to talk very rapidly, almost to the point where you can’t understand them, goes from one point to another – extreme agitation) , promiscuous behavior Bipolar II Less severe Hypomania Depression Don’t get as agitated- people go off medication because they like how they feel but than go into depressive mood and don’t like how they feel All the same emotions You cannot live with this you need medication Left untreated can turn into bipolar one Cyclothymia Chronic hypomania and depression Less severe symptoms Not as disruptive Rapid Cycling- found in childhood 4 cycles a year? You can see whats going on Early sign of manic-depression may be hypomania Hypomania may feel good to the person who experiences it If left untreated, bipolar disorder tends to worsen Etiology of Mood Disorders Biological- genes Neurotransmitter systems- serotonin, norepinephrine and dopamine Age of onset, prognosis, gender, and etiology of mood disorders o Depression: any time Adulthood: 30 For adolescence you want to watch them because you have to take into consideration their brain is not fully developed Bipolar: late teens early adulthood Prognosis; not something that can be cured, similar to depression Gender: equal Etiology: biochemical even if there is trauma Symptoms of mania Prognosis of Bipolar disorder Neurotransmitters implicated in Bipolar disorder Treatment for Depression and Bipolar Disorder o Lithium: weight gain, possible toxicity o Mood stabilizers- Depakote o 20-30% of children and adolescents with depression receive treatment o high comorbidity requires combination of treatments: CBT has 70% success, CBT used as a maintenance therapy as well, selective serotonin reuptake inhibitor (SSRI) o if no medicine works ECT (electroconvulsive therapy)- current of electricity passes through the frontal lobes, problems with memory loss (apparently comes back afterwards) o Transcranial magnetic stimulation- magnetic coil delivers pulses to neocortex o Vagus nerve stimulation- implanting a pacemaker-like device that generates pulses to the vagus nerve influences NT production( stimulates brain stem and limbic system(emotional processing) effects the production of neurotransmitters, FDA approved) o Medication: tricyclic medication has not shown to be effective with children or adolescents o Tricyclic antidepressants- eg imitriptyline (neurogenesis in hypocampus) o MAO inhibitor- block enzyme MAO that brakes down norepinephrine and serotonin o St. Johns Wort- herb o SSRI: most effective Prozac for youth o 2004 FDA toned down their warning on SSRI medications o decrease in teen suicide since antidepressants have been prescribed Risks for suicide o Family history of suicide; particularly at risk if a sibling has it and it is something they looked up to o Previous attempts o Giving away possessions o Stockpiling medications o Suicidal talk o Isolation o Renewed energy after deep depression Suicide is the second leading cause of death for ages 10-24 o Third leading cause of death for college-age youth and ages 12-18 Chapter 8 – Anxiety Disorders, Obsessive Compulsive Disorder, and Related Disorders Cognitive, Physical, and Behavioral symptoms of anxiety o Immediate physical reaction: fight or flight response Chemical effects- adrenaline, noradrenaline Cardiovascular effects- heart rate increase Respiratory effects- quickening of breathing Sweat glands effects- perspiration increases to cool the body Other body effects- pupils dilate, decreased digestive system, muscles tense o Cognitive: thoughts of being scared or hurt, thoughts of appearing foolish, thoughts of bodily injury, thoughts of going crazy o Behavioral Avoidance Crying or screaming Nail biting Trembling Swallowing Thumb sucking Avoidance of eye contact Symptom picture, age of onset, prognosis, etiology, and gender of the following anxiety disorders: o Separation Anxiety disorder (SAD) Around age 7-8 Excessive worry about being separated from mom and dad Worries about things that could separate them from mom and dad Can go away if its addressed Age inappropriate, excessive, and disabling anxiety about being apart from their parents or away from home Fears differ with age and may intensify 4-10% in children more common in girls SAD and Specific Phobia are the most common anxiety disorders in childhood 1/3 of children with SAD progress into adulthood School refusal- based in SAD but many reasons for the specific development Good prognosis if you address it Might develop because the family uproots at a young age and moves, may make a child who is genetically predispositioned to this or other anxiety disorders o Generalized Anxiety disorder (GAD) Anxious about everything (many aspects of child’s life) “what if?” GAD: problems with relaxation, sensitive to fearful stimuli Autonomic restrictors; they do not process images (images are processed in the right hemisphere and they only process in the left in terms of worrying) Cognitive avoidance- autonomic restrictors Presentation: Self-conscious Interpersonal problems Worried about meeting others expectations Seeks approval Set unusually high standards for themselves/highly self- critical Muscle tension, headaches, irritability Intolerance for uncertainty Typically occurs in adolescence (after 11yrs old) Children might be over sensitized, predisposed to it Prognosis is good if you get the help you need The long you wait the more of a problem it is going to be 3-6% of all children, equally common in boys and girls slightly more in girls o Specific Phobia A person has an extreme fear of a specific thing or object Go out of your way to avoid that thing 4-10% more common in girls than boys Most common co-morbid d/o- another anxiety d/o Autonomic arousal to feared object Disruption of activities Created through classical conditioning and maintaining through operant conditioning DSM- Subtypes of specific phobia Animal: examples include the fear of dogs, snakes, insects, or mice. Animal phobias are the most common specific phobias Natural environment: examples include the fear of storms, heights or water Blood-injection-injury: these involve a fear of being injured, of seeing blood or of invasive medical procedures, such as blood tests or injections (treated differently than how you would be treated for phobias in general) Situational: these involve a fear of specific situations, such s flying, riding in a car or on public transportation, driving, going over bridges or in tunnels or of being in a closed-in place, like an elevator Other: these include fear of falling down, a fear of loud sounds, and a fear of costumed characters, such as clowns age of onset: 7-9 years, can develop at any time o Social Phobia Child will go to great lengths to avoid others they don’t know or unfamiliar situations They are now being judged by another adult Fear of being evaluated, judged May feel very anxious about ordinary activities 1-3% of children and adolescents slightly more in girls nd most common 2 anxiety disorders 20% comorbid with depression and or substance abuse age of onset: early to mid adolescence rare before age 10 o Selective Mutism Failure to talk in specific social situation Social phobia Parents might have had a problem with this Cause is unknown Rare and Higher in girls Comorbid with: Communication disorder Social phobia Phonological disorder Expressive language disorder Auditory processing problems o Obsessive Compulsive disorder Most common obsessive fear in children is contamination Problems within the brain itself: basil ganglia, for physical behavior and movement, frontal lobe Reason why medication is such an important part of this Adolescents- sexual, somatic, religious, preoccupation Norm is more than one obsession Checking, washing/brushing teeth, bedtime rituals, counting, walking a prescribed pattern Age of onset 9-12 years 2-3% clinic based studies of younger children twice as many boys as girls OCD in younger children is not felt as abnormal A lot of boys get it younger than girls Old children try to hide their compulsions from parents and teachers ½ to 1/3 of children with OCD continue to display symptoms 2-14 years later fewer than 10% show to complete remission Predictors for poor outcome: Psychopathology of parents Lifetime history of tic disorder Poor initial response to treatment o Panic attacks Sudden overwhelming period of intense fear or discomfort Short duration approx. 10 min(worst of it) then diminish over the next 30 min. or next few hours Impending danger or doom Out of nowhere Fight or flight symptoms Rare in children Nocturnal panic attack- develops as a result of body temperature dropping Are treatable o Panic disorder Recurrent unexpected attacks followed by 1-month concern over having another attack. Constant worry over consequences of an attack Person really develops primarily a strong fear of having another panic attack 3-4% panic attacks, 1% panic disorder 15-19 years lowest rate of remission of all anxiety disorders With or without agoraphobia Nocturnal panic attacks o Agoraphobia Fear of fear Catastrophic believe that their anxiety will lead to socially unacceptable consequences Driven by negative consequences of experienced anxiety in public Worst case scenario is a person is completely house bound o Hoarding disorder Recent disorder -2013 See this in children Can come on on its own Difficult situation in which they are not able to give up some of their collection Their collections become huge Even the thought of giving something up (even used coke bottle), memories, specific emotions are tied to these objects Medication can help o Post-Traumatic Stress disorder (PTSD) Persistent anxiety following an overwhelming event or events that occur outside of the normal human experience Symptomology might not develop for 3-6 months Actual or threatened death or injury or the threat to one’s physical integrity Usually a trigger to something (psychic numbing) Most common events in childhood to cause PTSD: Major accidents Natural disasters Kidnapping Brutal physical assaults War and violence Sexual abuse Symptoms of PTSD: Avoidance of associated stimuli Psychic numbing Exaggerated startle response Hyper vigilance Nightmares (helpful, they need to process this) or flashbacks Dissociation/derealization/depersonalization May display a chronic course with remissions and relapses Therapeutic Interventions o Systematic desensitization: using the ability to help the person calm down, deep breathing techniques, then hierarchy of scary events o Flooding – response prevention: have to sit with problem, over time (couple to many minutes) the feeling goes away o Cognitive behavioral therapy: dealing with cognitions, faulty thoughts that have developed over time that are incorrect, where is the evidence for your belief about xyz o Graded exposure: without the anxiety and deep breathing you jstu go with exposure to phobia Chapter 9 – Attention Deficit Hyperactivity Disorder and Related Problems Core features and symptoms o Persistent pattern of inattention, and or hyperactivity- impulsivity which is more intense than what is typically seen in children of the same developmental stage o Selective attention, attentional alerting, sustained attentions o Running or talking non-stop o Acting without thinking o Inability to sit still and pay attention o Barkley- self-control issues and that it all hangs on self-control o Having problems with working memory, unable to control thoughts Age of onset, course and prognosis o School aged, preschool too o Does change o 6.8% of children ages 4-10 o 11.4% of children ages 11-14 o 10.2% of children ages 15-17 o symptoms will change over a period of time (ages) o when teenager, slowing down of physical problems they will still have attentional problems o good prognosis if person is on medication and in talk therapy Most common comorbid disorders o *ODD o *Conduct disorder o Depression o Anxiety disorders Positive Self- Bias o Refers to when a child feels like everyone is okay with their behavior if they are hyperactive- this can be completely wrong o Might be protective factor o To not believe this would mean to believe that no one likes them o Defense mechanism ADHD –PI (predominately Inattentive) o Selective attention or distractibility o Inability to sustain attention or focus attention for a period of time o Probably ADD o With girls in particular o Child who is spacey, looking out the window, distracted o Disorganized o Socialized to be pleasers ADHD- HI (hyperactive impulsive) o May present differently with each child o Impulsivity- inability to control actions o Cognitive and behavioral impulsivity o Behavioral impulsivity o Not able to stay seated o Will be physically active (boys) o Running around like a motor is inside them ADHD –C (combined type) o Risk for development of conduct disorder/ODD o Symptoms of both inattention and hyperactivity-impulsivity o everything Associated features o Cognitive deficits-executive functions (frontal lobe) o Attention inhibition, arousal levels, response to reward, time perception, working memory o Affect how they perform in school o Socially difficult because there are social rules you have to follow growing up and they do things out of the social rules o Helped as soon as diagnosed o self-regulation non-verbal working memory internalization of speech- verbal working memory self-regulation of affect, motivation and arousal temporal processing or underestimating the passage of time delay aversion o Hyper focus Brain structures and neurotransmitter systems implicated in ADHD o Dopaminergic pathways o Frontal straeta o Basil ganglia- movement, disregulated o Dopamine is disregulated o Brain volume is about 5% smaller in kids with ADHD o Nervous system are not quite as developed (immature)- they act like the 3 or 4 year old when they are older than such Working memory, self-regulation, passage of time, motoric issues o Most of these kids are bright o They might feel like they are stupid o Once they get on medication, they show improvement o Barkley says core system is inability to self-regulate and working memory will not work properly if we cannot control our memories o Some kids have no sense of how long something is going to take o Can be clumsy Gender features o Boys get diagnosed around 7 o Girls around 12 o Presents differently o Girls are more motor mouth, they just have to talk o Teachers just think she isn’t interested instead of thinking its ADHD Social problems o Girls are more social, socialized to be pleasers o go undetected Medication and other treatment modalities
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