Child and Adolescent Psychopathology 4.pdf
Child and Adolescent Psychopathology 4.pdf Psyc 5020
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This 15 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 3 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 12: Trauma Child Abuse & Neglect (CAN) Significant problem since the early 1970’s In US, estimated that one in ten children experience some form of sexual victimization by an adult or peer Maltreatment: Any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act which presents imminent risk of serious harm 4 Primary Acts of Maltreatment-Can have overlay Physical-10.8% o Multiple acts of aggression (i.e. punching, beating, kicking, burning, shaking) o Injuries are the result of “over disciplining” o Often described as more disruptive and aggressive because they have seen that modeled for them Neglect-78.3% o Most common o Physical Abandoning a child Inadequate supervision Refusal for a runaway to return home Refusal or delay in seeking health care o Educational Failing to enroll a child in school Failing to attend to a child’s special educational needs o Emotional Cold, not providing warmth or affection Spousal abuse in the child’s presence Permission of drug or alcohol use; allowing them to have a party at their house o Show a range of behavior patterns from undisciplined activity to extreme passivity o Medical Neglect: 2.4% Sexual-7.6% o Range of behaviors from fondling to sodomy o It can happen one time or multiple times over many years o Can affect behavior, development, and even affect physical health (STD’S) o Reactions of sexually abused can vary depending on the nature of the assault Many acute symptoms resemble children’s common reactions to stress o Exploitation Commercial exploitation: Child labor & prostitution Significant form of trauma for children and adolescents worldwide-10 million children are victims Emotional/Psychological-7.6% o Repeated acts or omissions that may cause serious behavioral, cognitive, emotional, or mental disorders o Can exist in all forms of maltreatment and can be just as harmful Other: 9.6% Non-Accidental trauma Wide ranging effects of maltreatment on the child’s physical and emotional development Victimization Abuse or mistreatment of someone whose ability to protect himself or herself is limited Learning what is ethical behavior PTSD Acute Stress Disorder: Less severe form (1 month) o PTSD is longer o Intrusion of thoughts, dissociation, negative mood, avoidance of reminders and people, arousal (essentially the body’s way of protecting itself) Adjustment Disorder: Children who react to more common forms of stress in an unusual manner Diagnostic Criteria of PTSD o A. Directly experiencing a traumatic event o B. Presence of one or more intrusion symptoms associated with the traumatic event o C. Persistent avoidance of stimuli associated with the event o D. Negative alterations in cognitions and mood associated with the event o E. Marked alterations in arousal and reactivity o F. The duration of disturbances is more than 1 month o G. Disturbances cause clinically significant distress in important areas of functioning and disturbances are not attributed to any substance o Even learning that events happening to someone close to them Parents of children who have cancer can develop symptoms of PTSD o Feelings of detachment of estrangement from others-Don’t trust others anymore o Heightened periods of arousal Children 6 and under o Might have intrusive memories but aren’t as distressed by it o Socially withdrawn from others o Disinterest in activities o Derealization-Thinking that everything is a dream Associated Problems o If not treated, PTSD can last throughout life TF-CBT (Trauma Focused CBT) Purpose o Help to control intrusive or upsetting thoughts related to the trauma o Therapist helps to avoid cues, situations, and feelings associated with the event o Identify unhelpful cognitions about event o Help child prepare for reminders of the event Narrative o Exposed to the event over and over until it doesn’t cause them anxiety o Decide what format: Book, poem, pictures o How to proceed: Forwards or backwards o Encouraging client to add facts about event as well as thoughts and feelings o Ask to include description of worst moment or memory describing it in detail o Explore and correct cognitive distortions o Employ relaxation techniques if needed o Praise and rewarded at end of session-children enjoy this more o Help the child to create an optimistic ending Remind them that the event is only one part of their life Jaycee Lee Dugard was abducted at 11 Health Related Disorders Sleep Disorders Can cause psychological problems, result from other disorders, or mimic or worsen existing symptoms Sleep deprivation impairs brain functioning of the prefrontal cortex which leads to decreased concentration, and diminished ability to inhibit or control basic drives, impulses, or emotions Primary sleep disorders are the result of abnormalities in the body’s ability to regulate sleep/wake mechanisms as well as the timing of sleep Infants/toddlers: Wake up more in the middle of the night Preschoolers: Falling asleep problems Younger school aged children: Defiant, not wanting to go to sleep Dyssomnia: Disorders of initiating or maintaining sleep Parasomnia: Disorder in which behavioral or psychological events intrude on ongoing sleep o Involves psychological or cognitive arousal at inappropriate times during sleeping and waking o Complaints of unusual behaviors while sleeping o Mid childhood o Nightmares, sleep terrors (They don’t know what scared them or they don’t remember; more scarier than nightmares) and sleepwalking Treatment o Behavioral interventions (extinction, planned ignoring, bedtime fading, CBT) o Identifying causes of disrupted sleep-what’s happening before they go to bed o So important to stay consistent! o With nightmares, soothing the throughout the day so they are not so scared when going to bed Elimination Disorders (Children usually outgrow these disorders mainly because treatment is very effective) Enuresis (Bedwetting) o Nocturnal only: most common 4-13% of children under 10 Adolescence: declines to 1-2% o Diurnal: more common in females; only during day time May be associated with social anxiety 3% 6 year olds o Combination of both More common among less educated, low SES o Treatment Causes include deficiency of ADH, immature mechanisms, and genetics Behavioral training methods Medications (synthetic ADH) Psychological interventions (urine alarm), which are more effective than medications Encopresis: Passage of feces in inappropriate places o Is it medical and uncomfortable or is it more defiant or attention seeking behavior? o Primary: 4 years old without establishing fecal continence (never done this before) o Secondary: Have had continence in the past but now they have stopped o Causes Avoiding, suppressing, not recognizing signs when it is time for a bowel movement o Treatment Going to be more individualized depending on the reasons for why they are not going to the bathroom Chronic Illnesses Transactional Stress and Coping Model o Views the child’s illness as a stressor to which the family must respond Disability Stress Coping Model o Children’s ability to cope with chronic illness depends on risk and resilience factors in the family Asthma o 6% of children have attacks o Could also be embarrassing to pull out an inhaler o Could be acute or long term-Working on that balance Cystic Fibrosis o Condition that causes thick mucus in the airways and lungs o Scary and uncomfortable for the child when they have to participate in exercises in the hospital Have to be really careful about interactions so they don’t get others sick Diabetes Mellitus o Body is unable to metabolize carbs as a result of inadequate pancreatic release of insulin o Lots of social issues o No gender differences o Rates of the disease are increasing o Behavioral strategies: help promote regimen adherence, metabolic control, family adaptation, reinforcing the child for using their insulin Childhood Cancer o Onset in children is more sudden and more often at the advanced stage when first diagnosed (because no one expects a child to get this) o Most common form is acute lymphoblastic leukemia o More likely for a relapse due to their young age o 80% of cancer patients survive and 50% require serious medical long term care Research shows that kids are very good with structure-scary when there is none Gastrointestinal Problems o Irritable Bowel Syndrome Diarrhea and constipation o Irritable Bowel Disease More serious-Crohn’s disease Diarrhea, rectal bleeding, urgency, abdominal discomfort Juvenile Rheumatoid Arthritis o Lots use a wheelchair Sickle Cell Disease o Mainly with African Americans o May use wheel chairs as well from the acute pain Development o More likely to suffer emotional and behavioral adjustment problems o Most adapt successfully to their illness o Effects on family members Family support PTSD in family members Siblings experience heightened social and mental health problems o Social adjustment and school performance Submissive behavior with peers and engaging in less social activity 5 C’s of Consultation-Liaison Crisis: Helping the parents to understand the illness Coping: How the child is going to cope with the illness, what the treatment is going to be Compliance: Teaching the child to follow regimens Communication: Psychologist is the in between man Collaboration: Big part Treatment Overall Behavior Therapy o Systematic desensitization Teaches the child to relax while going through their hierarchy o In vivo exposure o Operant Conditioning-Reinforcement and punishment Cognitive Therapy o Cognitive Restructuring-Challenges their thoughts Role Playing Guided Imagery: Replacing thoughts about a medical procedure with thoughts of a peaceful place Refocusing: More conversational Feeding Disorders -Occurs in early childhood Avoidant Food Intake Disorder Persistent failure to meet appropriate nutritional or energy needs associated with significant weight loss, significant nutritional deficiency, dependence on enteral or oral nutritional supplements, or marked interference with psychosocial functioning Diagnostic Features: All based on clinical judgment o Not keeping a good weight or being able to grow appropriately o Significant nutritional deficiency: Physical examinations or lab testing o Dependence: Does the child need something extra that helps them eat G-Tube-Not long term; also going along with social settings o Not concerned with excessive concern about body weight or appearance, where eating disorders come in o Making sure there are no medical factors or mental disorders o Pure food avoidance or food selectivity (more about the severity, even though we all have preferences) (appearance, color, smell, texture-less work required to eat, temperature, taste) Development o Can happen at any age o No link between avoidant food intake disorder and later onset eating disorders o Infant and developmental impairments can affect outcome o Coexisting parental psychopathology o Child abuse or neglect Risk Factors o Temperamental Anxiety disorders, ASD (very big on food selectivity), OCD, ADHD disorders o Environmental Familial anxiety, higher rates from mothers who have eating disorders (more of the relationship with food) Behavior is shaped up by the parents o Genetic & Physiological Stomach issues, vomiting Treatment o Escape Extinction-Not going to be able to escape the food Representation: Spitting out the food and putting that spit up food back in your mouth Redistribution: When they won’t swallow, move the food around in the back of their mouth Reinforcement becomes contingent on taking a bite o Oral Motor Training: Training how to chew their food o Parent Training o Self Feeding Skills Pica Ingestion of nonedible substances for at least one month (hair, insects, paint) for at least one month o Eating not based on nutritional value but rather just the urge to eat nonedibles Occurs in children with intellectual disabilities Determining if the problem is socially or automatically maintained More prevalent among institutionalized children Causes & Treatment o Causes have not been determined o Vitamin or mineral deficiencies o No evidence of genetic factors o Treatments are based on operant conditioning procedures and teaching caregivers to keep the child’s environment tidy and removing dangerous substances from reach Rumination Disorder Repeated regurgitation of food over a period of 1 month (just the food itself and not vomiting) o Re-chewed, re-swallowed, spitting out Not attributable to associate stomach or any other medical conditions Chapter 13: Substance Use Alcohol Forms Naturally fermented (max 14%) o Beer, wine, mead Distilled (max 95%) o Everclear Soluble in both water and fat Absorption takes place in the stomach and in the upper intestinal tract o 30-90 minutes for full absorption-Why it is good to eat before drinking Men v. Women Men: More diluted for them due to more muscle than fat Women: More body fat, therefore harder for us to metabolize the alcohol like men can Takes 1 hour to metabolize 1 drink Concentration Effect Relationship .4-.5: Death (lungs stop working to bring in oxygen), deep coma, unconscious Long Term Health Effects Exacerbates ulcers Cancer in head, neck, oral and GI-stomach (very dangerous) Liver disease o Fatty liver, Fibrosis, Cirrhosis Cardio Vascular disease Accidents and violence The Standard Drink Beer-12 oz. (2 ndfrom the top line of solo cup) Wine-5 oz. (2 ndfrom the bottom line) Liquor-1.5 oz. (Bottom line) Statistics Substance Abuse and Mental Health Services o Binge Use: 5 or more drinks on the same occasion on at least 1 day in the past 30 o Heavy Use: 5 or more drinks on the same occasion on each of 5 days or more in the past 30 Starts at 12 years old! Greatest is from 21-25 (Current use + bingeing + heavy use) Alcohol Use 18-25: More men than women Highest is among whites, Asians are the least (in current use) o Asians lack a certain enzyme that allow them to metabolize alcohol easily 52% current drinkers 23% binge drinking at least once in a 30 day period 6% heavy users Yearly Costs $300 billion overall in US 22,000 deaths, 2 million injuries 4.6 million vehicle damages 15%-25% healthcare budget Adolescent Substance Use Disorders (SUD’s) Criteria: One or more harmful and repeated negative consequences of substance use over the last 12 months 8 categories of abuse (alcohol is the big one) Becomes a problem if it is interfering with daily activities Tolerance + withdrawal Early remission (less than 12 months) Sustained remission (12 months or longer) Prevalence & Course Alcohol is the most prevalent, marijuana has been on the rise Cigarettes have been declining Cannabis could bring on psychosis much earlier (if you already have the genetic predisposition for it) Illicit drugs such as crack, cocaine, and opiates has also increased Over 50% are using alcohol senior year Age of Onset Some amount is of course normal Age of use is a risk factor o Odds of developing an alcohol dependence decreases by 9% for each year that onset of drinking is delayed o Alcohol use before 14 is a strong predictor of alcohol abuse in the future Hispanics have more of a higher use for hard core drugs African Americans have lower usage rates than whites Sex differences have converged due to the higher prevalence rate of women drinking Course Typically peak around late adolescence and decline around young adulthood Alcohol influences involvement in other high risk behaviors such as drinking and driving, unsafe sexual acts Girls who report dating aggression are 5x more likely to use alcohol than girls in nonviolent relationships; while boys are 2.5x more likely Associated Characteristics Using more than one drug simultaneously (hard because you don’t know which one is affecting the person the most) Poor academics, high rates of academic failure, high rates of delinquency More parental conflict Disruption of neurodevelopmental processes o Affects the teenage brain more than adults High comorbidity with ADHD and conduct problems Personality Characteristics Increased preference for seeking out new things Positive attitudes about drinking and having friends with similar attitudes Trying to be more adult like Disconnected to school Causes Family functioning-lack of parental involvement o Lower trust between teenage girls & their parents Peers & Culture o Misconception that everyone’s doing it o Glamorized by the media Alcohol Harms Study UK-Heroin, meth o Found that alcohol was causing the most problems along with crack, heroin, cocaine, and meth o Least was mushrooms College Drinking Usually doesn’t start in college but before Doesn’t matter if you’re in college, 18-24 is the prime time Full time students drink more than part time Perceived v. Actual Norms Usually a disconnect between reality Majority are not drinking on campus-people are over-perceiving this Alcohol Related Consequences Drinking and driving Unconsented sex Treatment Models HBAC Personalized Feedback o Educating students on what is going into their use of alcohol (calories and money) o Harm reduction model How to drink safely (but you don’t have to be abstinent) Came out as a reaction from all the scare tactics Alcohol, opioids, stimulants, and gambling are all considered substance-related & addictive disorders Impaired control, social impairment, risky use, and pharmacological criteria are all categories for grouping substance abuse Kelly Osbourne first abused drugs at 13 and used Vicodin Chapter 14: Eating Disorders Disturbances in eating behaviors, thoughts, and emotions (not just about the food) Anorexia Nervosa Not taking in the appropriate amount of calories for their age and weight Intense fear of gaining weight or becoming overweight Disturbance in the way in which one’s body is experienced (body dysmorphia) Driven to lose weight through exercise, purging, and caloric restriction Obsessions and compulsions worse with weight loss Highest mortality rate (from suicide and lack of nutrients) o 10% will die within 10 years of onset MUST BE UNDERWEIGHT Health complications o Loss of period o Irregular heartbeat o Low blood pressure o Muscle loss and weakness o Poor circulation in hands and feet o *Memory loss o Growth of lanugo hair Bulimia Nervosa One can fluctuate between anorexia and bulimia Lack of control over eating AND eating in discrete amount of time large amounts of food Some inappropriate behavior of preventing weight gain Use food to cope with stressful times Low self-esteem Frequency of bingeing & purging increases as the behavior persists Average duration is 8.3 years-faster recovery than anorexia Cycle o Pursuit of thinnessRestrictive dietingDeprivation/hungerBingePurgingGuilt & shame and cycle starts over again Health complications o Electrolyte imbalances o Rupture of stomach o Tooth decay Binge Eating Disorder Most common out of all Affects men and women equally Eating and eating but not looking for a way to get rid of the food; lack of control Eating rapidly, eating until you are uncomfortably full and even when not hungry Occurring at least one a week for 3 months Health Complications o Overweight o Type II diabetes o Sleep apnea Warning Signs of Eating Disorders Starts off pretty secretive because if not, someone could intervene and stop what they are in control of doing Fainting-with people with anorexia Fluctuations of weight or significant weight loss or gain Getting cold easily, weakness Hot flashes, sweating Everyone can get an eating disorder Can’t just look at someone and tell that if they have an eating disorder Athletes are more susceptible to getting an eating disorder Age of Onset As young as 7 or 8, but more common in ages 16-20 Risk Factors Genetics Brain abnormalities-differences in the hypothalamus Emphasis of thinness in our society Family dysfunction Gender (being female) Perfectionism (more anorexia) Negative body image Childhood sexual abuse Treatment Some medications are used (but not a strong case for efficacy) Family therapy (for Anorexia) Appetite suppressants (Binge Eating Disorder) CBT, in particular Dialectal Behavior Therapy (mainly with bulimia) Typically takes a team for treatment Importance of Body Image The Thin IdealHealthy ideal o Impossibly thin female body type-put on by our culture Fat Talk: 3-5 minutes increases body dissatisfaction
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