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Child and Adolescent Psychopathology 4.pdf

by: aiy0001

Child and Adolescent Psychopathology 4.pdf Psyc 5020

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The fourth and final test covers: Chapter 12: Trauma Chapter 13: Substance Use Chapter 14: Eating Disorders + Health Related Disorders, Feeding Disorders
Child and Adolescent Psychopathology
Dr. Brestan-Knight
Class Notes
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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 thinnessRestrictive dietingDeprivation/hungerBingePurgingGuilt & 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 IdealHealthy ideal o Impossibly thin female body type-put on by our culture  Fat Talk: 3-5 minutes increases body dissatisfaction


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