Childhood Disorders Final

According to the Life Span Institute, what are the guidelines for accurately representing disabilities in media?

1. People first

2. Emphasize abilities

3. No condescending euphemisms

4. Active participants

5. do NOT focus on disability

6. no superhumans or heroes

7. DO not sensationalize a disability

8. no generic labs

Autism Spectrum Disorder (ASD) include 5 developmental disabilities of childhood. Please list them below.

1. Autistic Disorder

2. Asperger Syndrome

3. Childhood Disintegrative Disorder

4. Pervasive Developmental Disorder NOS

5. Rett’s Syndrome

List some examples of diagnostic criteria for Autism:

1. Impaired in social interaction

2. Impairment in communication

3. Restricted behavior, interest and activites

List some examples of core features in Autism: Communication:

• Poor communication abilities, some never acquire functional speech

• Speech is less frequent than normal peers

• Content of speech is unrelated to immediate environmental events

• Repetitive and stereotyped utterances

• Inability to use speech in a social communicative fashion

• Delayed or immediate echolia

• Unusual volume of speech

• Impaired non-verbal communication

List some examples of core features in Autism: Insistence on Sameness:

Restricted Repertoire of Activities or Interests:

• Distress over trivial changes

• Ritualization of daily routine

• Obsessional interests and attachment to unusual objects

• Intense, narrow range of interest

• Stereotyped behaviors (body rocking, hand flapping, toe walking)

• May insist that others behave in similar rigid ways

List some examples of core features in Autism: Social Interactions:

• Reciprocal Social Interactions

• Infancy-do not develop normal attachments to parents or caregivers

• May be stiff or rigid when held

• Tend not use smiling, gestures, or physical contact to signal social intent

• Eye contact is usually poor, avoidant, or otherwise deviant

• Fail to develop specific peer friendships

• Rarely engage in cooperative peer play

• Normal displays of affection and demonstrations of empathy are uncommon

• Imitation skills are impaired, and imaginative play is typically absent

List some examples of associated features in Autism Intelligence:

• IQ ranges from profoundly mentally retarded to superior

• High functioning autism

• Low functioning autism

• Autistic savants

• 80% receive a concurrent diagnosis of mental retardation

• 60% have IQ’s less than 50

• IQ tends to remain stable in middle of childhood and adolescence

• IQ predicts academic accomplishment

Autism- Self-Injurious Behaviors:

• Result in direct physical harm to person exhibiting

• Repetitive and stereotyped

• One of the most serious and debilitating problems associated with autism

• Examples include biting, hitting, head banging, hair pulling, and scratching

• Occurs in approximately 40

Autism- Stimulus Overselectivity:

• Respond to only a component of available sensory information

• Focus on one minute feature of an object or person rather than the whole

• Selective processing of sensory information contributes to:

  • Insistence on sameness

  • Problems in generalizing skills

  • Difficulties in initiating language in response to complex social cues

Etiology of Autism: Myth

• Bad parenting (e.g., "refrigerator mothers") was wrongly blamed but is false.

• Vaccines do not cause autism; this has been thoroughly disproven

• Emotional trauma or neglect is not a cause of autism

• Autism is not a mental illness, but a neurodevelopmental condition

• Poor diet or toxins alone do not cause autism

1. Etiology of Autism:- Truth

• Autism has neurobiological origins

• It is strongly linked to genetic factors, often through complex inheritance

• Prenatal and perinatal risks may also contribute, but not as primary causes

What are the Autism Assessment Measures used?

• Childhood Autism Rating Scale (CARS)

• Autism Diagnostic Interview-Revised

• Gilliam Autism Rating Scale (GARS)

• Functioning Emotional Developmental Levels (FEDL)

• Functional Emotional Developmental Questionnaire (FEDQ)

Treatment of Autism: Behavioral Treatment Example

• Applied Behavior Analysis

• Discrete Trial Training

• Lovaas Method

Treatment of Autism Relationship-Based Treatment Example:

• DIR ('Floor-Time' approach)

  • D - developmental relationship (where are they?)

  • I - individual differences (follow child’s needs)

  • R - relationships

Classroom Interventions Examples: Autism

• intensive, specialized, and focused instruction for children with autism

• social skills

Greenspan and Wieder's Developmental Ladder:

1. Self-regulation and interest in the world

2. Engaging and relating (intimacy)

3. Two-way communication (intentionally)

4. Complex communication (problem solving, mood regulation, and a sense of self)

5. Creating symbols and using words and emotional ideas

6. Emotional thinking

List the features of Asperger's Syndrome:

1. Qualitative impairment in social interaction

2. Restricted, repetitive, and stereotypes behaviors

3. Significant impairment in important areas of functioning

4. No significant delay in language

5. No significant delay in cognitive development, self-help skills, or adaptive behaviors (other than social interaction)

6. Problems with nonverbal communication

7. Physical clumsiness

What core deficits does treatment in Asperger's Syndrome aim to address?

Communication, motor clumsiness, social skills training, etc.

Definitions of other Autism Spectrum Disorders in the DSM?

• Normal development for first 2 years

• Loss of previously acquired skills in 2 areas (i.e. play, motor skills, language)

• Similar features to autism: restricted behavior, communication and social interaction

Rett's Disorder:

• Deceleration of head growth b/w ages 5 and 48 months

• Loss of purposeful hand skills between 5 and 30 months

• Impaired expressive and receptive language

• Loss of social engagement

Pervasive Developmental Disorder NOS (not otherwise specified):

Nonverbal Learning Disorder:

• Neurologically based deficits of sending and receiving nonverbal language

• Often confused with anxiety and social withdrawal

• Categories of Deficits

• Motoric

• Visual-spatial organizational

• Social

• Sensory

What does ACEs stand for?

Adverse Childhood Experiences are potentially traumatic events that occur in childhood (0-17 years).

What are some examples of traumatic events that occur in childhood?

• Experiencing violence, abuse, or neglect.

• Witnessing violence in the home or community

• Having a family member attempt or die by suicide

What are some environmental examples of that may undermine the child's sense of safety, stability, and bonding while growing up?

• Substance use problems.

• Mental health problems

• Instability due to parental separation

• Instability due to household members being in jail or prison

What percentage of adults in the United States report that they have experienced at least one type of ACE before age 18?

64%

What are the 11 categories of Trauma?

1. Community and School Violence

2. Complex Trauma

3. Domestic Violence

4. Medical Trauma

5. Natural Disaster

6. Neglect

7. Physical Abuse

8. Refugee and War Zone Trauma

9. Sexual Abuse

10. Terrorism

11. Traumatic Grief

What assessment measures are given when assessing for a trauma diagnosis?

• Trauma Symptom Checklist

• ACEs

• Variety of PTSD Scales

Define trauma and stressor related disorders listed in the DSM-5: (handout)

1. Post Traumatic Stress Disorder (PTSD):

2. Acute Stress Disorder

3. Reactive Attachment Disorder (RAD)

4. Disinhibited Social Engagement Disorder (DSED)

5. Adjustment Disorder

6. Other specified Trauma and Stressor Related Disorder

7. Unspecific Trauma and Stressor Related Disorder

Post Traumatic Stress Disorder (PTSD):

Re-experiencing, avoidance, and hyper-arousal symptoms following a traumatic event that are diagnosed at least four weeks after trauma exposure.

Acute Stress Disorder:

Dissociative, re-experiencing, avoidance, and hyper-arousal symptoms following a traumatic event that are diagnosed after lasting two days to four weeks after trauma.

Reactive Attachment Disorder (RAD):

This disorder is diagnosed only in children. RAD affects infants and very young children. A child with RAD has a pattern of showing disturbed and developmentally inappropriate attachment behaviors. The child rarely or minimally turns to an attachment figure for comfort, support, protection, and nurturance

Disinhibited Social Engagement Disorder (DSED):

This disorder is diagnosed only in children. Children with DSED exhibit overly familiar and comfortable behavior with relative strangers

Adjustment Disorder:

Emotional and behavioral symptoms in response to an identifiable stressor, such as termination of a relationship or a persistent painful illness

Other Specified Trauma and Stressor Related Disorder:

This category applies when symptoms characteristic of a trauma- and stressor-related disorder do not meet the full criteria for any of the disorders included in the trauma- and stressor-related disorders diagnostic category

Unspecified Trauma and Stressor Related Disorder:

This category also applies when symptoms are characteristic of, but do not meet the full criteria for any of the disorders included in the trauma- and stressor-related disorders diagnostic category. However, this category is used when the clinician chooses not to specify why the criteria are not met or there is sufficient information, such as during an emergency room visit.

Potential difficulties after exposure to trauma: Physical/Physiological:

• Hypersensitivity to physical contact

• Numbness

• Problems with coordination and balance

• Increased somatization

Potential difficulties after exposure to trauma: Medical

• Asthma

• Autoimmune disorders

• Pseudo-seizures

• Sleep disturbances

• Disordered eating

Potential difficulties after exposure to trauma: Cognitive:

• Attention

• Executive functioning

• Learning

• Lack of sustained curiosity

• Problems processing new information

• Difficulties with language

• Impairments in auditory, visual, or spatial perception and comprehension

Potential difficulties after exposure to trauma: Attachment/Relationships:

• Distrust of and/or uncertainty about those around them

• Difficulties with boundaries

• Interpersonal difficulties

Potential difficulties after exposure to trauma: Behavioral:

• Behavioral (impulse) control

• Self-destructive behavior

• Aggression

• Difficulty complying with rules

• Oppositional behavior

• Excessive compliance

Potential difficulties after exposure to trauma: Emotional

• Affect regulation

• Dissociative symptoms (e.g., depersonalization or derealization)

• Amnesia

• Low self-esteem

• Shame or guilt

• Disturbance of body image

• Lack of a predictable sense of self

What are the principles of Trauma Therapy (Briere & Scott):

1. Therapeutic Relationship as Foundation

2. Respect for Client Autonomy

3. Emphasis on Affect Regulation

4. Attention to Dissociation and Fragmentation

5. Gradual Exposure to Trauma Content

6. Integration of Traumatic Memories

7. Attention to Relational Issues

Integrated Treatment Approach

1. Attachment Theory

2. Expressive Therapies

3. Cognitive Strategies

4. Family Systems Therapy

What are some Evidence Based Treatments for Trauma when working with children?

Eating Disorders: (NEDA website on moodle, under the section for children). List some biological risk factors for an eating disorder

• Having a close relative with an eating disorder

• Having a close relative with a mental health condition

• History of dieting

List some psychological risk factors for an eating disorder:

• Perfectionism

• Cognitive inflexibility

• Impulsivity

• Avoidance motivation

• Body image dissatisfaction

List some social risk factors for an eating disorder:

• Weight stigma.

• Teasing or bullying

• Appearance ideal internalization

• Limited social networks

What are some key markers and symptoms of Anorexia Nervosa?

• Dramatic weight loss

• Dresses in layers to hide weight loss and/or stay warm

• Is preoccupied with weight, food, calories, fat grams, and dieting

• Refuses to eat certain foods, and often eliminates whole food groups

• Has intense fear of weight gain, even though underweight

What are some key markers and symptoms of Bulimia Nervosa?

• Preoccupied with weight, shape and appearance leading to restriction/dieting behaviors to promote weight loss

• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food

• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

• Appears uncomfortable eating around others

• Develops food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn't allow foods to touch)

How does society and media portray eating disorders and/or body image?

• Glorification of -Thinness

• Stereotyping Eating-Disorders

• Minimization or Romanticization

• Focus on Appearance Over Health

Health Related Impairments: What types of health impairments are you most likely to see?

• ADHD

• Asthma

• Diabetes

• Epilepsy

What are the 3 tasks of working with kids and families with cancer?

1. Preparation for medical experience (preparing family and child)

2. Separation from caregiver

3. Extended hospitalization/Return home

List some expressive play examples:

• Target Shooting with Syringes (target symbolic of experiences)

• Punching activities

• Pounding/Banging Activities

• Cooking activities

• I-Body Tracings

List some dramatic play examples: (Preparing for Medical Procedures)

• Medical, nursing equipment

• Sick doll, role play (idea of hospital doll)

• Doll demonstration

• Importance of reflections during play

• Talk about feelings, concerns

List some familiarization activities: (Preparing for Medical Procedures)

• Collages-with medical materials

• Bandaid ornaments and necklaces

• Mobiles

• Water play

• Exploration and manipulation

• Decorating medical equipment

List some separation issues activity examples:

• Stories

• Family Communication

• Looking for Mom & Dad Game

• Dramatic play with family dolls

What are some important things to remember when transitioning from hospital to home?

• Acknowledge ambivalence

• parents support kids

• Resources

• Prepare children for changes

• Talk about feelings (family)

• Sense of closure

• Children will be missed

• Continued contact