child psychopathology exam 1

Dr. Vivek Murthy

• suicide rates have risen over past decade

• COVID-19’s effects

• future well being of country depends on how we support next generation

how is psychopathology different in children

• more/different referral sources

• often involves developmental delay

history of psychopathology

• children were property to be caged

• psychoanalytic theory: importance of childhood

• first juvenile court focused on rehabilitation

• behaviorism: children/behavior can be shaped

• Piaget/Vygotsky: cognitive development through childhood

• Bronfenbrenner: importance on environment psy

psychopathology

• usually involves distress, impairment, inability to adapt/develop

• does not predispose one to violence

characteristics of psychopathology

• low SES

• marginalization/oppression

• maternal smoking, D&A use, mental illness

• abuse neglect

median age of onset of psychopathology

14

what terminology do people with psychopathology prefer

person first

sensitive period

optimal windows for learning/skill acquisition

biological theories of psychopathology

• experiences alter gene expression

• most psychopathology is poly genetic

• brain structure/function and endocrine system

hyperactive HPA causes

anxiety

underdeveloped or low dopamine in prefrontal cortex causes

ADHD

psychological theories of psychopathology

• emotions direct us to approach or avoid

1. extreme high or low emotional reactivity can lead to dysregulation

2. temperament affects attachment

• personality disorder rarely diagnosed in childhood

• principles of learning and cognition shape behavior

sociocultural theories of psychopathology

• social environment grows more complex as child ages

• attachment style affects relationships/development

• family systems therapy

assessing disorders

• conduct clinical interview, build rapport

• assess severity via rating scales, checklists

• observe identified patient in other settings

• administer a test to compare intelligence

• administer a questionnaire or projective test to determine personality traits

• use anatomical dolls to assess abuse in young children

• medical or neuropsychological testing may link behavior change to psychological issues

assigning a disorder via DSM

• 5 symptoms over a 2 week period

  • systematically describes each disorder along with: prevalence, development, culture and gender diagnostic issues, differential dx, comorbidity

  • list diagnosis first and any specifiers

    • oppositional defiant disorder, moderate

core principles of treatment

decrease stress, increase motivation, decrease maladaptive thoughts, increase adaptive thoughts

prosocial behavior

raising your hand and speaking not yelling it out, sharing, manners

psychodynamic treatment

unconscious conflict= increase awareness

cognitive/behavioral treatment

some more effective at dealing with different disorders

client centered treatment

cause of maladaptive behavior= conditions of worth

neurobiological treatment

abnormal behavior is treated with medicine or change of diet; ECT

intellectual disability

lifelong but may change overtime, diagnosed at a severe level with good training may move to a less severe level

definition of ID

onset during developmental period and deficits in intellectual function and adaptive function

deficit in intellectual function

reasoning, problem solving, planning, judgement, learning from experience; confirmed by clinical assessment and IQ tests

flynn effect

increase in IQ over generations; 3 points per decade

deficit in adaptive function

failure to meet developmental and sociocultural standards for personal independence and social responsibility that limit activiteis of daily living

mild ID

85%- learning difficulties/delays in school; may live independently in adulthood with appropriate supports (1.6:1 M:F ratio)

moderate ID

10%- language develops slowly; academic progress, social judgement and decision making are markedly limited; Down Syndrome

severe ID

3-4%- organic causes likely, more physical problems; minimal speech/math abilities; require support for most ADLs 20-40 IQ (1.2:1 M:F ratio)

profound IQ

1-2%- may understand simple instructions/gestures; dependent on others for all care 20 or less IQ

prevalence of ID

1%+ higher rates for low SES

organic causes of ID

• prenatal - chromosomal abnormalities (down syndrome, fragile X); teratogens- smoking, alcohol, drugs, malnutrition

• perinatal- prematurity, birth asphyxia, head injury, infections

• postnatal- neurotoxins, TBI, bacterial meningitis, measles

cultural/familial causes of ID

neglect, deprivation, unstimulating environment, low SES

prevention of ID

prenatal care/education; make supports available

treatment of ID

• early educational intervention for high risk children

• behavioral therapy to strengthen speech, model behaviors

• involvement in least restricted environment, Special Olympics

• self instructional training

• teach self advocacy skills

• educate/support families

when did autism disorder show up

in DSM-III (1980)

where do you see deficits in ASD

• social emotional reciprocity

• nonverbal communicative behaviors used for social interaction

• developing, maintaining, and understanding relationships

patterns, interests, activities of ASD

• stereotyped or repetitive movements, speech or use of objects

• insistence on sameness, inflexible adherence to routines, patterns

• highly restricted, intense fixation in objects or interests

• hyper or hypo reactivity to sensory input

catatonia

frozen position common in ASD

common symptoms/features of ASD

• theory of mind and executive function deficits

• odd gait, clumsiness, self injurious behaviors

• pronoun reversal, echolalia

• minimal social interest, reception/processing and expression of emotion

• struggle in novel, unsupported situations; self-stimming/soothing

• scan faces differently

what percentage of those with ASD have co occuring dx

90% (ID, epilepsy, anxiety disorders, ADHD)

prevalence of ASD

1-2% of population

M:F ratio of ASD

4:1

age of diagnosis of ASD

5 yrs old; later for girls

causes of ASD

1. older parental age

2. extreme prematurity and/or low birth weight

3. teratogens

prevalence of childhood onset schizophrenia

1 in 10,000

jenny ASD

7 yo, complicated birth, 3 weeks premautre, minimal social connection with family

jennies symptoms

• slapped interns

• took glasses off of people

• didn’t like change

• hair pulling

• self stimming

• echolalia

• bad language skills

jenny treatment

• behavior therapy ABA to teach/reward use of sign language and picture book

• ADL’s improved with much prompting

• meds