PSYC 2011.11 Day 15 Notes - 11/19/15
PSYC 2011.11 Day 15 Notes - 11/19/15 PSYC 2011
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This 8 page Class Notes was uploaded by Oona Intemann on Monday November 23, 2015. The Class Notes belongs to PSYC 2011 at George Washington University taught by Woodruff, P in Fall 2015. Since its upload, it has received 108 views. For similar materials see Abnormal Psychology in Psychlogy at George Washington University.
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Date Created: 11/23/15
NOTES THURSDAY 111915 Reading for this week Chapter 17 Disorders of Childhood and Adolescence Bottom of page 32 Usually a child wouldn t be able to refer him or herself BUT something would be noticed by a parent or teacher Sometimes dif cult for parent emotionally to acknowledge that the child has a problem Childhood anxiety disorders Separation anxiety O 0000 0000 Child shows anxiety or panic when he or she is not with a major gure or in unfamiliar surroundings Might not be able to stay in a room by themselves Might refuse to go to school Uncomfortable visiting the home of a friend When you ask the child why he or she is afraid they might say I might get lost etc Have exaggerated fears of accidents kidnappers etc In early childhood almost every child experiences separation anxiety But for this to be diagnosed there must be a reaction for at least four weeks Treatment is very effective I Best is play therapy I Toys are speci cally selected by the therapist to help the child through the play activity I Also family therapy so the child isn t singled out I Systematic desensitization Wolpe hierarchy of fears and teach yourself to relax I Hypnosis sometimes been effective I 14 years ago the FDA approved Luvox antidepressant in children 617 so sometimes they re given that as well as an antianxiety Phobias O O In children almost always speci c In most they outgrow it but some children have phobias that are so severe and intense that they need to be treated I School phobia I Modeling is the most effective the model is not the therapist but another child I Usually matching the child with the phobia I Also systematic desensitization works here I Children can be a little more relaxed so they counter the anxiety I Then cognitive therapy where the child learns a few positive statements I I am great I can take care of myself Childhood depression 0 For a long time thought it was only in adults 0 About 2 of children and 9 of adolescents have depression O O 0 Symptoms I Withdrawal Crying very easily or frequently Poor appetite Nopoor eye contact Sense of helplessness I Suicidal thoughts It has been found that children who didn t have suicidal thoughts previously who have them on medication You must monitor the child and they must regularly see a therapist Very few cases where a child or adolescent has actually died but many attempts have been made There s a black box warning with this if the child is between 617 The best approach is probably medication along with behavioral cognitive therapy I Change the thoughts I Improve the selfesteem There are far too few child psychologists and psychiatrists What we do know is that by ratio up until the age of 13 boys and girls are equal when it comes to getting this After 13 it s 21 female to male It s not just hormones could be ora in the stomach Prozac Paxil Zoloft and Effexor are used Bipolar disorder 0 00000 Most children are very rapid cyclers They can cycle a number of times in a single day If one parent has it there s a 30 of the child develop it If both parents 75 risk That is offspring of dual mating Too much activity in the amygdala emotions and too little activity in the prefrontal cortex rational thought I Usually start child on a mood stabilizer I Never really start the child on lithium because it s so toxic Kidneys intestine I Then they might be put on an atypical antipsychotic Seroquel That leave the child very hungry and with weight gain It can also leave the child with ticks I Finally an antidepressant may be added I Individual and family therapy are very much recommended as well as limiting caffeine I Then a change to that the child and preferably the rest of the family live with a routine I Some feel that the diagnosis is overapplied I 66 are boys Disruptive mood regulation disorder 0 Sudden outbursts of rage you look at the situation and can t understand what has caused it Oppositional de ant disorder 0 00000000 0 This is where a child shows negative hostile and de ant behavior for at least siX months Defying adult rules Annoying others but also annoying themselves Easily losing temper Being very angry resentful towards others repeatedly Blaming others for their problems Being spiteful and vindictive More common in boys until puberty and then after that the gender ratio is equal Some develop something even more serious conduct disorder Might have onset in childhood or adolescents Conduct disorder 0 O O O O 0 ADHD O OOOOOOOOOOOOOOOOOOOOOO Lying cheating stealing setting res vandalism Cruelty to animals When kids break the law they re juvenile delinquentsoffenders Sometimes they have surrogate parents who constantly try to reinforce socially approved behaviors It s still very hard to treat I They might come out of a facility and go right back in I This happens a lot Some of these kids simply remit and you never see the behavior again Has gone by many names Years ago we called it minimal brain dysfunction 1950s started calling it hyperkinetic syndrome of childhood 1980 attention de cit was used for the rst time 1987 hyperactivity was added to the majority of the cases About 70 are male Disorder lessens as the child goes through adolescence About 13 keep it into adulthood There is ADHD predominantly attentive type 20 Then ADHD predominantly hyperactive type 80 There is a form where there s a combination They show some cognitive impairment in impulsiveness etc Interrupting while others are talking Doing dangerous things without considering the consequences They re also accident prone Then the hyperactivity The inability to remain in one s seat If you can get the child to stay in the seat they wriggle Then there s dgeting Inattention Not following directions There s often also learning disabilities depression Some develop conduct disorder o Seem to be a number of causes I Running families I Dopamine norepinephrine serotonin and glutamate are also involved Probably a combination of genes too We know the cerebellum is a little smaller is the third that extends through the Ritalin is the most common treatment It s related to amphetamines It was the earliest and has been in generic form now for years Wellbutrin and Zyban I Both psychostimulants I Increasing the dopamine increases impulse control I Ritalin can have positive shortterm effects I Weight loss I Outbursts of rage I Some have ticks I People who carry this into adulthood there might be cardiac problems I Sometimes they get headaches etc OOOOOO Teachers have to be specially allowed to administer this medication January 2003 Stratera new drug First to not be a psychostimulants Had the potential for abuse It increases the norepinephrine It only needs to be taken once a day at home It doesn t cause insomnia They re still doing studies to compare it to Ritalin 2006 Nitrana became available for ages 612 Administers Ritalin via in injection People who work with children who have ADHD say to never rely on medication alone There really needs to be behavioral therapy Modification of behavior lots of positive reinforcement Hitting spanking yelling at child is totally ineffective Family therapy you can teach the parents to be calm around the child Feingold Diet Dr Feingold believed that sugars and certain food dyes attributed to ADHD The recommendation is to avoid these kinds of food low in carbohydrates certain food dyes In a tiny subset of children this works Many parents feel it s worth trying anyway Other treatments include Magnets in the bed or in a bracelet These are not effective Personal life coaches to do the behavior modi cation Swimming with dolphins some say this helps There is a common recommendation that when a child is diagnosed you work with the parents as well often you will nd it unrecognized in the parents If you can stabilize the parents you may be able to stabilize the child The outcome is not always good 0 Children with ADHD have a higher rate of dropping out of school being unemployed teen pregnancy having car accidents spending time in jail There is a book called Buzz A Year of Paying Attention O 0000 O O 0 She was diagnosed with ADHD at the same time as her 10yearold son She and her husband had excellent income She was a journalist he was an editor They had two sons The mother and the child tried every type of treatment except for medication together for a whole year the son got some of the royalties Did any of it work No They both ultimately went on medication But she had the money and the time to try all the alternatives Ritalin on campuses O O O The usage is abused It keeps you up to study write papers Memory retention while on Ritalin is unknown Two elimination disorders Bed wetting enuresis O 0 00000 Child involuntarily wets the bed during the night or the pants during the daytime Persistent dif culty controlling urination by a chronological age of ve and a mental age of four You must be sure it is not caused by a physical problem allergies UTI Must be two events per month between ages ve and siX and one event per month by age seven or older for three consecutive months Most children do outgrow it because it causes distress Two ways to treat it I Set an alarm this is hard on the parents every two hours wake up and take child to bathroom I Bell and pad pad on the child that has a sensor and a bell as soon as the rst drop of urine hits the pad the bell rings the child wakes up and then can go to the bathroom on his or her own If the child helps strip the bed etc this will help Limit liquids as the evening goes on quiet activities These kinds of therapies can be effective There are also underpants that t any size for incontinence At one point the military would not take anyone who had enuresis as an adult Encopresis o Passage of feces of normal consistency into the clothing or onto the oor 0 Must be a chronological and mental age of at least four and an episode of once a month for three consecutive months Need to rst be checked for any physical problem Sometimes this is tied into constipation Very little research has been done Family therapy has been found to be helpful with lots of positive reinforcement Sometimes has to do with environment 00000 The Autism Spectrum Autism Spectrum Disorders Higher functioning is more commonly Asperger s It was here in the US Johns Hopkins that Leo Kannner prominent child psychologist in 1943 first used the term infantile autism It is a PDD persistent developmental disorder About 80 are male The spectrum consists of certain characteristics 0 Unresponsive to others 0 Poor communication skills Difficulty playing with others 0 Odd reactions to the environment 1998 1 in 2000 2008 1 in 150 O 2012 1 in 88 2041 1 in 48 male 1 in 68 female Why is this 0 Are we better at diagnosing it Do we have a better understanding of the disorder 0 Could be something in the environment 0 VACCINES DO NOT CAUSE AUTISM Kanner suggested that relationships between the parents and child could be disruptive 0 Mother was a refrigerator parent cold and unemotional with the child hadn t bonded o Mothers in particular were blamed for this Today we know that it is a lifelong neurological problem Appears with the normal development of reasoning 0 Makes learning diff1cult 0 Can lead to serious behavior problems 0 Can be evident in the first few weeks of life or sometimes the child is as old as three 0 The concordance rate with identical twins is 90 I This means that there has to be a genetic component with it Seems to be abnormal development in the cerebellum 0 Excessive amount of white matter in the brain 0 Glial cells that support the neurons greatly enlarged frontal lobes O 0 Brain is normal size at birth but by age of two the head may be as big as an adolescent o Pediatricians are thus urged to regularly among other things measure the head size at various times We think that there are as many as 15 genes that play a role in this and that mutated genes are involved This spontaneous mutilation is thought to come from the father There is a high rate of older fathers where you have an autistic child There are three broad areas of symptoms 0 Failure to develop social relationships Baby does not care if it is held They seem to not need affection Do not make eye contact with the caretaker Don t seek comfort when distressed They don t smile sometimes No imitative behavior No social play They become preoccupied and form strong attachments to objects 0 Language and communication de cits 50 never learn to speak Some are mentally retarded so some comorbidity About 5 have isolated skills or great talent in art music or mathematics This is called being a savant They used to be called idiot savants They may be able to do great things in a field but cannot do very basic other things Echolalia may repeat phrases spoken by others even same accent or in ection sometimes Delayed echolalia hours or days later will repeat many times the phrase they heard Pronominal reversal reverse or confused pronouns They are having a good time when the child means I am having a good time Make up nonsense words 0 Limited imaginative play and responses to environment Selfinjurious behavior Head banging against things Sometimes bite parts of their bodies Can pull out their hair Selfstimulating behavior Spinning Hand apping Walking on tiptoes Body rocking Grimacing Fascinated with movement I Preservation of sameness Must have the same kind of things all the time furniture has to be in the same place must speak to the child in the same way Treatments we have so far 0 Haldol antipsychotic I Given with vitamin B6 and magnesium I Helps some children with language development I Can reduce tantrums and selfstimulating behavior 0 Behavior therapy I First introduced by late Ivar Lovaas I Program that parents paid their child to go through 40 hours a week for two years Parents would then work with child on weekends and evenings I It worked with certain behaviors I If a child came close to a behavior that the adult desired the child would be given a reward I He also used punishment electric shock sometimes 0 Facilitated communication I Therapist puts hand out I Child s hand is over the therapist and there is keyboard in front I Child communicates that way Books 0 The Curious Incident of the Dog in the Nighttime Haddon