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Child and Adolescent Psychopathology 2.pdf

by: aiy0001

Child and Adolescent Psychopathology 2.pdf Psyc 5020

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The second test covers: Chapter 5: Intellectual Disabilities Chapter 6: Autism Spectrum Disorder Chapter 7: Communication & Learning Disorders Chapter 8: Attention Deficit Hyperactivity Disord...
Child and Adolescent Psychopathology
Dr. Brestan-Knight
Class Notes
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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 untreatedpoor, 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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