Child and Adolescent Psychopathology 2.pdf
Child and Adolescent Psychopathology 2.pdf Psyc 5020
Popular in Child and Adolescent Psychopathology
Popular in Psychology (PSYC)
This 13 page Class Notes was uploaded by aiy0001 on Sunday August 21, 2016. The Class Notes belongs to Psyc 5020 at Auburn University taught by Dr. Brestan-Knight in Spring 2016. Since its upload, it has received 4 views. For similar materials see Child and Adolescent Psychopathology in Psychology (PSYC) at Auburn University.
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Date Created: 08/21/16
Child & Adolescent Psychopathology Chapter 5: Intellectual Disabilities Mental Retardation-Intellectual Disability (ID) Shift in how the general population and medical field view ID th Prior to 19 century: People with ID were ignored and feared o We know that today this is not the way to go ID: A significant limitation in intellectual functioning and adaptive behavior before the age of 18 History of ID Very important for the field of child psychology Samuel Howe opened up the first humanitarian institution in North America in the mid 19 Century 1940’s: Parents increased humane care for children-more likely to keep them at home if they had a disability Evolutionary Degeneracy Theory o Children with mental retardation were viewed as regression to an earlier period in human evolution o J. Langdon H. Down interpreted these strange anomalies as throwbacks to the Mongol race Binet and Simon-1900’s o Commissioned by the French Government o Came up with the first intellectual test for children-for those who were gifted and those who were struggling o Still available today (not really common though) If someone is given an IQ test multiple times, they might become “test wise” A plan B to the Weschler IQ Test General intellectual functioning is now defined as intelligence quotient (IQ) o ID is defined on the basis of IQ (Weschler scales) and level of adaptive functioning Adaptive Functioning How effectively does the individual cope with ordinary life demands How capable is this person with living independently Mental retardation early back was based solely on the basis of IQ Vineland IQ and adaptive function Parent and teacher report measure Domains (of what the child can do) o Communication o Daily living skills Domestic (cleaning the table, do they know how to use utensils?) Sometimes parents will take on the caretaking role because they think it’s easier to do it themselves Community: Does they understand money? How the phone works? Again, the parent might buckle their seatbelts for them, but does the child know how to do it? o Socialization Eye contact-being attentive Play Understand the rules? o Cant track who’s “it” in tag Gullibility: Being take advantage of, not realizing they are being tricked or manipulated o Motor Skills Fine Holding a pencil Gross Can they skip? Go upstairs? o Maladaptive behavior Internalizing and externalizing Have to buy these measures (so not anyone can get these practices) o As much $1 million IQ Relatively stable over time For infants, you don’t really measure this but instead motor skills Can be taken for a child as young as 3 Mental ability is always modified by experiences o Going to grad school-increase in abilities o On the other side, having parents doing things for the child Flynn Effect: The phenomenon that IQ scores have risen about 3 points per decade Some has argued that the IQ test is biased or unfair o Some people aren’t good test takers! o Children with ADHD have lower scores-timed performance, sometimes just boring Why there are norms for these kinds of kids o Hard for someone who was born in another country-Terms might be different o If someone was hearing impaired-Might not understand directions and therefore, use a different test altogether o How the child is brought up could effect test taking-Raised by grandma who has a hearing impairment Diagnostic Criteria Considerable range of abilities and interpersonal qualities o Questions is two people are really in the same category DSM 5 o Deficits in intellectual functioning Reasoning, problem solving, academic experiences o Impairments in adaptive functioning Personal independence, navigate world through social responsibilities and skills o Must be evident prior to 18 Severity Levels Mild o 85% of people with an ID have a mild severity o Might not be identified until early elementary years Hard for parents to not know why their kid is having these problems 6-7 years old is when you know language developments are on board o Overrepresentation of minority groups o Develop social and communication skills o Live successfully in the community as adults with appropriate supports o Might not be evident on the surface Moderate o 10% of people with an ID o Pretty clear early on-Identified in Preschool o Applies to people with down syndrome o Benefits from vocational training-Publix workers o Can perform supervised unskilled or semiskilled work in adulthood Severe o 3-4% of people with and ID o Usually due to organic causes o Identified at a very young age Ultra sounds can sometimes pick this up o Delays in developmental milestones Facial features are different o Mobility issues or health problems Need special assistance throughout life Live in group home or with family Profound o 1-2 % of people with an ID o Identified at infancy o Never learn how to speak o Require intensive training for eating, grooming, toileting, and dressing o Require lifelong care and assistance Prevalence o 1-3% of population o Twice as many males in mild population (at higher risk for several disorders) o More prevalent among children of lower SES o The more severe though, the more equal across different SES levels Risk Factors o Biomedical Prenatal Mental illness Parent age-older parents are a higher risk Abuse of mom Perinatal Preemie babies Birth injury Lack of access of prenatal care Postnatal Traumatic brain injury (car accident) Malnutrition Seizures Chronic illness in family-child is neglected o Social o Behavioral o Educational Role of Environment Genes are potentially modified by the environment Genotype: Genes that pertain to intelligence Phenotype: the expression of the genes in the environment (gene-environment interaction) Understanding Down Syndrome Extra copy of 21 chromosome Nondisjunction-increases with maternal age Abnormal nuchal fold Follows a predictable and organized course of development o Underlying symbolic activities intact o Considerable delay in expressive language development Expressive is weaker than receptive language Understands what people are saying but can’t talk back o Very friendly and happy-fewer signals of distress or desire for proximity o Delayed but positive development of self-recognition o Delayed functioning in internal state language o Deficits in social skills and social cognitive ability Can lead to rejection by peers Chapter 6: Autism Spectrum Disorder ASD: Abnormalities in social behavior, language, communication skills, and unusual behaviors and interests Kanner (1943) was the first to coin the term “early infantile autism” to describe young children with autistic symptoms o Not as easy to pick out more mild symptoms of Autism Asperger Disorder (1944): Milder form of Autism Autism is biologically based and a lifelong neurodevelopmental disability o Genetically predetermined o Not something we cure with psychology techniques o Process of building up skills (over a long period of time) World wide: 100 children per 10,000 may suffer from some form of Autism o Autistic Disorder: 22 of 10,000 o PPD-NOS: 33 of 10,000 o Asperger’s: 10 of 10,000 o 1 million in US o Occurs in all social classes and identified worldwide Age of onset o Identified by the parents in the months preceding the child’s 2d birthday Diagnosis is made in the preschool period o Earliest point of reliable detection is 12 months of age Diagnoses made around 2-3 years are generally stable AAP recommends that all children should be screened at 18-24 months Pretty time intensive process and very detailed Causes of ASD o Biologically based with multiple causes Problems in early development Genetic influences Brain abnormalities A disorder of risk and adaptation DSM-5 Defining Features o Impairments in social interaction (no reciprocity) Understanding relationships-What makes a friend? o Impairment in communication o Restricted repetitive and stereotyped patterns of behavior, interests, and activities Could think of OCD with the repetitive patterns o Intellectual disability is not a criteria but may co-occur The Spectrum o Children may differ in the level of intellectual ability from profound disability to above-average intelligence o Behavior changes wit age Core Deficits o Aspects are development are interconnected o Restricted and repetitive behaviors and interests Insistence on sameness behaviors Repetitive sensory and motor behaviors Same kind of music or none at all Theories of self-stim behavior A craving for stimulation to excite their nervous system Blocking out unwanted stimulation from environment that is too stimulating o Yelling to want the light to go away Maintained by sensory reinforcement it provides o Social emotional impairments Social reciprocity Unusual nonverbal behaviors Social limitation, sharing focus of attention (early signs), make believe play Limited social expressiveness Atypical processing of faces and facial expressions Why kids with Autism like Thomas the Tank Engine Joint attention o Language development Declarative gesture (pointing, and early signs) About 50 % do not develop any useful language Those who begin to speak may regress between 12- 30 months-big warning sign! Children with ASD who develop language usually do so before 5 Impairments Pronoun reversals (I v. you) Echolalia (repeating what you say) Perseverative speech (wanting you to say something in a certain way) Impairment in pragmatic (not really understanding how language works-when something is funny or when someone is telling a joke) o Cognitive development Associated Characteristics o Intellectual deficits and strengths o Sensory and perceptual impairments o Cognitive and motivational deficits o Medical conditions (on average, not all) Intellectual Deficits and strengths o 70 % have co-occuring intellectual impairment o Common pattern is low verbal scores and high nonverbal o 25% have splinter skills Something they excel greatly in o 5% have remarkable talents Chapter 6: Child Onset Schizophrenia *Providing structure 1.) Is this truly onset schizophrenia? 2.) If it is, what is the best medication? COS: Atypical mental functions and disturbed behavior Characterized by severe psychotic symptoms (delusions or hallucinations), thought disturbances, grossly disorganized or catatonic behavior, extremely inappropriate or flat affect, significant deterioration or impairment in functioning A more rare and possibly more severe form Likely to persist into adulthood Likely to effect social and academic competence DSM Symptoms Positive o Delusions o Hallucinations: Auditory is most common (occurs in 80% of cases prior to age 11) Key feature is that across all other areas of life o Disorganized speech or behavior o (At least one of these) Negative o Slow thinking, speech, and movement o Emotional apathy: not having loving feelings towards others or not reciprocating o Lack of motivation to do things o (At least one of these and lasts at least for a month-with positive symptoms too) Be careful to rule out schizoaffective disorder Precursors Gradual onset Almost 95% have a history of behavioral, social, and psychiatric disturbances before onset of psychosis Might look like another disorder at first but as time goes on you start to see what the person truly has Prevalence Extremely rare in children under 12 Dramatic increase in adolescence (around 22 years old) Less than 1 per 10,000 children Earlier age of onset in boys (by 2-4 years) o Gender differences disappear in adolescence Causes Defect in neural circuitry-increases a child’s vulnerability to stress Strong genetic contribution o Doesn’t have to be schizophrenia-depression, bipolar, etc. Well managed with medication-tells us it has something to do with the brain Environmental o Chaotic family life (gene-environment interaction) o Not being very verbal (in parents too) o Personal tragedy (being born in the winter?) Negative thoughts from the parent Treatment Left untreatedpoor, long-term prognosis Antipsychotic medications and psychotherapy-best outcome o Meds can have serious side effects Social and educational support programs Comorbidity: Anxiety, depression, and substance abuse Chapter 7: Communication and Learning Disorders Learning Disability: Learning problems that occur in the absence of other obvious conditions Can also have co-occurring problems (can have someone who is gifted and have a learning disability) Term has been replaced in the DSM by more specific terms Affects how individuals of at least normal intelligence take in, retain, and express information Categories of Communication Disorders Language Speech-sound Childhood onset fluency Social pragmatic communication Specific Learning Disorders Having problems in a particular domain o Reading, math, or written expression (or could have problems with all 3 or 2) Determined by achievement test results that are lower than would be expected for one’s age, schooling, and intellectual ability o IQ test + test of achievement A discrepancy of more than 2 SD’s between the IQ findings and the actual achievement findings o Achievement: Test on spelling, math, ability to understand a reading passage o Achievement and IQ should generally not vary too much o Takes quite a few tests to determine this o Ask parent if they have had these problems before the age of 7-diabilities don’t just pop up Long time to get training to access for learning disabilities! Lots of overlap-building on similar parts of the brain Impairment in Reading Most common is the inability to distinguish or separate sounds in words Involves difficulty learning basic sight words: the, who, what, laugh, said o Sight word: Training to memorize on sight Errors in reversals o Mixing up B and D; P and Q; transpositions (was/saw; scared/sacred); inversions (M and W); and omissions (place for palace; section for selection) Gaps start in kindergarten and if it persists in 3rd grade, it’ll last through their academic career Fluency and speed is greatly impacted Core deficits o Decoding rapidly enough to read the whole word-coupled with problems reading single, small words Impairment in Writing Often associated with problems with eye/hand coordination-leads to poor handwriting Limited output in written work: shorter, less interesting and poorly organized essays Are less likely to review for spelling errors, punctuation, and grammar Likely to recommend core and upper body work outs for kids to work on their fine motor skills Impairments in Math Difficulty in recognizing numbers and symbols, memorizing facts, aligning numbers, and understanding abstract concepts Prevalence 2-10% of the population 5-17% with a reading impairment 20% with a math impairment (only 1% of school-aged children) Rare to have an impairment only in writing-usually overlaps with another domain o May affect 10% of children Social & Cultural Factors Less relevant to learning disabilities More common in males Development Daily experience can be exhausting-can cause children to become angry and have behavior problems in class Something that doesn’t go away by itself Psychological and Social Adjustment Behavior problems peak around 8 o Co-occurring problems arise such as conduct disorder, ODD, and ADHD Could also impair social skills Chapter 8: Attention Deficit Hyperactivity Disorder (ADHD) “Getting medicine for ADHD is like getting glasses for poor vision” Behaviors can change throughout ones age Mild v. severe symptoms Persistent symptoms of inattention, hyperactivity, and impulsivity History Recognized as a disorder for a very long time (but not in the right way) o 1900’s “Defective moral control” and “inhibitory volition” o Influenza epidemic from 1917-1926: Brain injured child syndrome o 1940-1950’s: Recognize the disorder as a neurological condition Minimal brain dysfunction o Late 1950’s: Hyperkinesis-Hyperchildactive syndrome o 1970’s: ADHD as we know it was first described Special Ed teachers and physicians were starting to learn more about this Core Characteristics Inattention (6 or more), hyperactivity (6 or more)-impulse control (6 or more): All can lead to how one crosses their developmental milestones 6 months of symptoms being present and in more than one setting Impairing the ability to do school work or socially Combined presentation: All 2; or subtype: Predominately inattentive or predominately hyperactive-impulsivity Specifying current severity from mild-severe Inattention Inability to sustain attention for repetitive, structured, and less enjoyable tasks (such as homework) Attentional capacity Selective attention: Tuning out the distractions Distractibility *Sustained attention/Vigilance: Doing a task for a long time (very boring) Hyperactivity-Impulsivity Inability to voluntarily inhibit dominant or ongoing behavior Hyperactive behaviors o Fidgeting/difficulty staying seated o Moving, running, touching everything in sight o Excessive talking, pencil tapping o Energetic, intense o *Great for going on trips with! Goal oriented Impulsive behaviors o Inability to control immediate reactions or to think before acting o Emotional: Impatience, low frustration tolerance, hot temper, quickness to anger, irritability o Behavioral: Difficulty in inhibiting responses o Cognitive Presentation Types Predominately inattentive type o More females o Have to work hard at the task at hand o Daydreamy, spacey o Extra time on test would be helpful to think through questions o Easily confused o Often anxious, apprehensive, socially withdrawn o Comorbidity with mood disorders o More common Predominately hyperactive-impulsivity o Rare o Preschoolers o May be a distinct subtype of the combined presentation Combined Presentation o Common o Most often referred for treatment Limitations of DSM Criteria Not supposed to diagnose children before age 5 Categorical view o Should be using more of a dimension approach-ADHD is about to what extent do we exhibit these symptoms DSM lag behind in research findings Associated Characteristics Speech and language impairments Developmental coordination and tic disorders Medical and physical concerns Social problems Study Guide Know diagnostic criteria for disorders (ID, ASD, COS, ADHD, and LD) Downs Syndrome questions Questions from presentations ‘Theory of Mind’ Autism video Prevalence rate for ASD Vineland (Ch. 5) Difficulties of having a learning disability and what it looks like in reading, math, and written expression (Ch. 7) History of ID and ADHD Associated features of ADHD
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