PSYC 535 Test 3

(12) Major Symptoms of Acute Stress Disorder

• Earlier onset, within 1 month of trauma

• Involuntary, distressing, persistent memories of the event

• Nightmares

• Flashbacks

• Intense distress

• Negative mood

• Dissociation (e.g., depersonalization)

• Avoidance (e.g., avoiding external cues)

• Arousal (e.g., sleep trouble, irritability, etc.)

(12) Major Symptoms of Adjustment Disorder

• Psychological response to a common stressor

• Can be in response to single/multiple events

• Occurs within 3 months of stressor

• Results in clinically significant behavioral/emotional symptoms

• Symptoms disappear when stressor ends/person adapts

(12) How does the HPA axis become altered in response to trauma?

Elevated levels of stress hormones, cortisol levels decrease from chronic stress

(12) With the HPA axis altered, how does that affect the developing brain?

Lower cortisol levels can cause the stress response system to behave unpredictably, and impact structure and function; may account for later psychiatric problems

(12) What does the P stand for in PRACTICE?

Psychoeducation/parenting strategies

(12) What does the R stand for in PRACTICE?

Relaxation skills

(12) What does the A stand for in PRACTICE?

Affective expression/regulation

(12) What does the C stand for in PRACTICE?

Cognitive coping / Conjoint parent-child sessions

(12) What does the T stand for in PRACTICE?

Trauma narrative/processing

(12) What does the I stand for in PRACTICE?

In vivo exposure

(12) What does the E stand for in PRACTICE?

Enhancing personal safety and future growth

(12) What is the goal of the Trauma Narrative/Processing step?

To help the patient gradually approach, organize, and reframe memories so they lose the emotional intensity, and be integrated into the person’s life.

(5) Defining characteristics of Neurodevelopmental disorders

• Early onset and persistent course

• Lasting alterations in neural development

• Accompanied by subtle delays in language, motor, and social development

• Frequently co-occur

(5) Evolutionary degeneracy theory

• Intellectual and social problems of children with intellectual disability were viewed as a regression to an “earlier period in human evolution”

• Throwback to the “Mongolian race”

(5) The Eugenics Scare

• “The science which deals with all influences that improve the inborn qualities of a race”

• Individuals with intellectual disabilities were threats to society (“morons” or “moral imbeciles”)

(5) How were ID’s diagnosed past vs. present?

Mainly based on low IQ, but now adaptive functioning is more prominent

(5) Diagnostic criteria of intellectual disabilities

• Deficits in intellectual functions, such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and learning from experience

• Deficits in adaptive functioning

  • Results in failure to meet developmental/sociocultural standards for independence and social responsibility

  • Limits functioning in things like communication, social participation, and independent living

• Onset of intellectual and adaptive deficits during the developmental period

(5) Major characteristics of Mild Severity

• About 85% of people with ID

• Not identified until early elementary years

• Overrepresentation of minority group members

• Develop social/communication skills

• Live successfully in community as adults with appropriate support

(5) Major characteristics of Moderate Severity

• About 10% of people with ID

• Identified during preschool years

• Applies to many people with down syndrome

• Benefit from vocational training

• Can perform supervised unskilled/semi-skilled work in adulthood

(5) Major characteristics of High Severity

• About 3-4% of people with ID

• Often associated with organic causes

• Identified at a young age

  • Delays in developmental milestones/physical features

• May have mobility or other health problems

  • Typically need assistance throughout life

  • Live in group homes/with family

(5) Major characteristics of Profound Severity

• About 1-2%

• Identified in infancy due to delays in development/biological anomalies

• Learn only rudimentary communication skills

• Require training for eating, grooming, toileting, and dressing

• Require lifelong assistance and care

(5) Which cases do biological factors account for?

Severe and profound, but not mild

(5) Risk factor Biomedical - Prenatal

• Chromosomal disorders

• Single-gene disorders

• Syndromes

• Metabolic disorders

• Maternal illness

• Paternal age

(5) Risk factor Biomedical - Perinatal

• Prematurity

• Birth injury

• Neonatal disorders

(5) Risk factor Biomedical - Postnatal

• Traumatic brain injury

• Malnutrition

• Seizure disorders

• Degenerative disorders

(5) Risk factor Social - Prenatal

• Poverty

• Maternal malnutrition

• Domestic violence

• Lack of access to prenatal care

(5) Risk factor Social - Perinatal

Lack of access to prenatal care

(5) Risk factor Social - Postnatal

• Impaired child-caregiver interaction

• Lack of adequate stimulation

• Family poverty

• Chronic illness in the family

• Institutionalization

(5) Risk factor Behavioral - Prenatal

• Parental drug use

• Parental alcohol use

• Parental smoking

• Parental immaturity

(5) Risk factor Behavioral - Perinatal

• Parental rejection of caretaking

• Parental abandonment of child

(5) Risk factor Behavioral - Postnatal

• Child abuse/neglect

• Domestic violence

• Inadequate safety measures

• Social deprivation

• Difficult child behaviors

(5) Risk factor Educational - Prenatal

• Parental cognitive disability without supports

• Lack of preparation for parenthood

(5) Risk factor Educational - Perinatal

Lack of medical referral for intervention services at discharge

(5) Risk factor Educational - Postnatal

• Impaired parenting

• Delayed diagnosis

• Inadequate early intervention services

• Inadequate special education services

• Inadequate family support

(5) Factors that affect overall adjustment of a child with ID

Inheritance, Environment, Neurobiological, Social, Psychological

(6) Major symptoms of Autism Spectrum Disorder

• Impairments in social interaction

• Impairments in communication

• Restricted, repetitive, and stereotypical patterns of behavior/interests/activities

(6) Factors that contribute to the spectrum nature of autism

• May differ in level of intellectual ability

• Vary in severity of language problems

• Behavior changes with age

(6) Lack of Joint attention

Difficulty to coordinate visual focus on the same object, event, or activity with another person for a social purpose

(6) Atypical processing of faces

Differences in how the brain perceives, recognizes, and extracts social/emotional information from faces

(6) Lack of Protodeclarative and Expressive Gestures

Significant disruptive in early nonverbal communication and join attention; serve as foundational blocks for spoken language, social bonding, and cognitive growth

(6) Preservative speech

The repetition of words, phrases, sounds, or specific tone of conversation

(6) Impairments in Pragmatics

Difficulties using verbal and non-verbal communication appropriately in social contexts

(6) Repetitive sensory and Motor behaviors

Repeated movements, sounds, or physical actions; “stimming”

(6) Insistence on Sameness

Strong preference for routine, a deep dislike of unexpected change, and a need for predictability

(6) Intellectual Strengths and Deficits

• About 70% have co-occuring intellectual impairment

• Low verbal scores and high nonverbal scores

• About 25% have splinter skills or islets of ability

• 5% display isolated and remarkable talents

(6) Theory of Mind deficit in ASD

Difficulty understanding or being aware of others’ and their own mental states

(6) Youth processing information

Tend to process information in bits and pieces rather than look at the big picture

(6) Reliable detection age and recommended screening age

12-18 months detected; 18-24 months screening

(6) ASD heritability

Highly heritable

(6) Cause of ASD

Biologically based, neurodevelopment disorder related to problems in early development, genetic influences, and brain abnormalities

(6) Siblings of Individuals with ASD

15-20% have broader phenotype

(6) Key features of Childhood-Onset Schizophrenia

• Delusions

• Hallucinations

• Thought disturbances

• Disorganized

• Catatonic behavior

• Inappropriate affect

• Significant impairment in functioning

(6) Difference between positive and negative symptoms of COS

Positive: not normally present
Negative: normally present

(6) Positive symptoms of COS

• Delusions

• Hallucinations

(6) Negative symptoms of COS

• Slowed thinking

• Speech

• Movement

• Emotional apathy

• Lack of drive

(6) Hallucinations vs. Delusions

Sensory perception vs. fixed, false belief

(6) COS prevalence & history

Extremely rare in children under 12; if present, children have history of behavioral, social, and psychiatric disturbances

(6) COS Biological model

Strong genetic contribution and disturbance in the development of the brain

(8) Core Characteristics of ADHD

• Inattention

• Hyperactivity-impulsivity

• Highly correlated

  • Predict different behavior/cognitive impairments

(8) Facet of attention that is most affected

Sustained attention

(8) DSM-5 Criteria for ADHD

• Inattention

• Difficulty sustaining attention

• Easily sidetracked

• Avoids/dislikes tasks that require sustained mental effort

• Often forgetful in daily activities

• Fidgety

• Often cannot remained seated

• Runs/climbs in inappropriate situations

• “Driven by a motor”

• Talks excessively

• Difficulty waiting their turn

• Interrupts others

Predominantly Inattentive Type (ADHD-PI)

• Inattentive, drowsy, daydreamy, spacey, in a fog, easily confused

• Specific learning disorders, process information slowly, trouble remembering things, low academic achievement

• Anxious, apprehensive, socially withdrawn, mood disorders

Predominantly Hyperactive-Impulsive Type (ADHD-HI)

• Primarily symptoms of hyperactivity-impulsivity

  • Fidgety, cannot remained seated, running, “on the go”, talking excessively, difficulty waiting, interrupting

• Includes preschoolers, limited validity for older children

• Rarest of the 3 subtypes

Combined type (ADHD-C)

• Children who have symptoms of both inattention and hyperactivity-impulsivity

• Most often referred for treatment

(8) Children with ADHD Intelligence

Normal intelligence, but impaired academic functioning; often diagnosed with learning disabilities

(8) Family problems

• Negativity

• Child noncompliance

• Excessive parental control

• Sibling conflict

• Maternal depression

• Paternal anti-social behavior

• Marital conflict

(8) Peer problems

• Often bothersome, stubborn, socially awkward, socially insensitive

• Often disliked and rejected by peers

• Few friends

• Unable to apply social understanding in social situations

• Positive friendships can buffer negative outcomes

(8) Accompanying Psychological Disorders

• Oppositional Defiant Disorder

• Conduct disorder

• Anxiety disorders (25%)

• Mood disorders

(8) Why is ADHD more commonly diagnosed in boys?

ADHD in girls often unrecognized/unreported, DSM criteria may be more appropriate to boys

(8) Unique experience for ADHD in Girls

Have severe problems in adolescence

• Peer rejection, conduct problems, deficits in academics, attentional skills, language abilities

More likely to develop eating disorder symptoms

(8) ADHD in Infancy

May be present at birth but no reliable/valid methods to identify

(8) ADHD in Preschool

• Hyperactive-impulsivity symptoms more visible and significant ages 3-4

• Symptoms that last at least 1 year are likely to have difficulties later in life

(8) ADHD in Elementary

• Evident when child starts school

• Oppositional defiant behaviors may increase/develop

• Ages 8-12, defiance/hostility may take form of serious problem

  • Self-care, personal responsibility, chores, trustworthiness, independence, social relationships, academic performance

(8) ADHD in Adolescence & Adulthood

• Many do not outgrow problems; some can get worse

• At least 50% of clinic-referred elementary continue to suffer

• Either outgrow/learn to cope

• Boredom, work difficulties, impaired social relation, depression, low self-concept, substance abuse

(8) Genetic risk factors

• If parent has ADHD, child has 60% chance of having ADHD

• 75% heritability estimates in twins

• Genes may contribute to expression of ADHD

  • Focus specifically in dopamine regulation, psychomotor activity, sensation seeking

(8) Prenatal risk factors in ASD

Mother’s use of cigarettes, alcohol, or other drugs during pregnancy

(8) Association with frontostriatal circuitry implication

Affects attention, executive function, delayed responding, and response organization

(8) Association with Dopamine and Norepinephrine

Deficiency in the availability of dopamine and norepinephrine