2nd + final psycho

what are obsessions

recurrent thoughts, urges, or images that are experienced as intrusive, and cause feelings of fear, disgust and incompleteness. attempts to suppress with other action or thought

thought suppression

trying to consciously avoid thinking specific thoughts

what are compulsions

repetitive behaviors or mental acts performed in response to an obsession, acts are aimed at preventing/reducing anxiety or stress or a dreaded situation

what is the diagnostic criteria in OCD

time consuming of 1+ hours a day, causes significant distress, not better explained by another condition

what is the impairment relevant to in children with OCD

school performance, assignments have to be just right

developmental milestones if impairment prevents independence

low insight in OCD is associated with

being of younger age, lower adaptive functioning and higher depressive symptoms

don’t confuse obsessions with

excess worry in GAD, preoccupations in addictions, guilty ruminations in MDD, preoccupation with appearance in body dysmorphic, special interests in ASD

don’t confuse compulsions with

difficulty parting in hoarding, ritualized eating in ED, impulsive behaviors in conduct disorder, repetitive behaviors in ASD

mean age of onset in OCD

19.5, those with earlier onset around age 10 are typically boys

what are the 2 comorbid disorders with OCD

adhd and tic disorder

relate the heightened of suicide in OCD to klonsky’s suicide model

pain and hopelessness through intrusive thoughts that may not match an individuals self-perception/morals, failed attempts to suppress thoughts

pain overwhelms connectedness through social withdrawal, avoidance of triggers

capability through ability to act of recurrent thoughts, emotional numbing

hoarding disorder

difficulty parting with possessions regardless of value resulting in accumulation that congest active living areas and compromises their intended use

why does hoarding happen

perceived need to save the items and distress associated with discarding

perceived utility, aesthetic value, sentimental attachment, fear of loss

body dysmorphic disorder

preoccupation with perceived flaws in physical appearance that are not observable/appear slight to others, repetitive behaviors in response, not better explained by eating disorder

body dysmorphic age of onset

12-13 years old

prevalence of body dysmorphic disorder

2.3% girls, 0.4% boys

why do people with BDD respond poorly to cosmetic treatment

the disorder is the difficulty with perception, not identity. addressing the concern does not make the worry go away

muscle dysmorphia

specifier in BDD, preoccupied with idea that build is too small/insufficiently muscular

who’s most affected in muscle dysmorphia

adolescent boys and men

trichotillomania

recurrent pulling of ones hair resulting in hair loss, repeated attempts to stop, behavior causes shame/distress

excoriation

recurrent skin picking resulting in lesions, repeated attempts to stop, behavior causes shame/distress, picking can target healthy skin, minor irregularities, lesions or scabs

prevalence and onset of trichotillomania and excoriation disorder

1%, onset in early puberty, more common in adolescent girls and women

commonalities in trichotillomania and excoriation disorders

may be triggered by boredom or anxiety, may cause pleasure/relief, often performed without others around, co-occurs with other body-focused behaviors (nail biting), chronic if not treated

what do we need to consider when diagnosing hoarding behaviors in children

need to distinguish between hobbies, items of sentimental/monetary value; careful assumptions based on media; developmentally appropriate saving behaviors (collecting rocks); children’s limited control over home/cleanliness

traumatic event

exposure to actual or threatened death, serious injury, or sexual violence by directly witnessing, witnessing as it occured to others, event happened to family or close friend, repeated or extreme exposure to aversive details

how does ptsd diagnoses differ in different ages

certain events may be threatening to children due to developmental stage, threatened death may include abandonment of a caregiver, sexual violence may include developmentally inappropriate contact without violence/injury, traumatic events for children are interpersonal and intentional

how do we understand other difficulties that lead to trauma-like symptoms

stressors such as major societal devastations, medical incidents other than sudden catastrophe, stalking, bullying, emotional abuse or neglect, repeated exposure to racism

PTSD-6Y

exposure to one or more traumatic events followed by new associated symptoms of intrusions, persistent avoidance OR negative changes in cognitions, alterations in arousal and reactivity

helpful ways to be sensitive about trauma in youth

informed consent, thoughtful framing of discussions, considerations of consent-forward engagement vs avoidance

post traumatic stress disorder

exposure to one of more traumatic events followed by new associated symptoms for one month of intrusions, persistent avoidance, alterations in arousal and reactivity

intrusions in ptsd

recurrent, involuntary distressing memories of the event, dreams, flashbacks, intense psychological distress to cues, physiological reactions to cues

persistent avoidance in ptsd

avoidance of thoughts, memories or feelings associated with event, avoidance of external reminders that arouse distressing thoughts

negative alterations in cognitions and mood in ptsd

unable to remember important aspects of event, negative and exaggerated beliefs about oneself/others/world, distorted cognitions about cause leading to self-blame, persistent negative emotional state, diminished interest in activities, detachment/estrangement from others, inability to experience positive emotions

alterations in arousal or activity in ptsd

irritable behavior, angry verbal or physical outbursts, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, sleep disturbance

traumatic event in PTSD-6Y

exposure to actual or threatened death, serious injury, or sexual violence by directly witnessing, witnessing as it occurred to others, event happened to parent or caregiver

changes to intrusion in PTSD-6Y

spontaneous/intrusive memories may not necessarily appear distressing and may be reenacted in play, marker physiological reactions to reminders of the event

changes to persistent avoidance OR negative alterations in cognitions in PTSD-6Y

substantially increased frequency of negative emotional states, diminished interest in activities including play, socially withdrawn behavior, persistent reduction in ability to experience positive emotions

changes to alterations n arousal or reactivity in PTSD-6Y

irritable behavior including temper tantrums

acute stress disorder

exposure to a traumatic stressor with 5 or more PTSD symptoms, symptoms persist between 3 days and 1 month

adjustment disorder

emotional or behavioral symptoms in response to an identifiable stressor within 3 months, distress is out of proportion to intensity, symptoms end within 6 months

prolonged grief disorder

persistent grief response from passing of 6 months ago in children, 12 months in adults. intense yearning for deceased, preoccupation with thoughts/memories

how would prolonged grief disorder manifest in children

somatic expressions of worry (stomach ache), frustration with individuals who attempt to perform activities in place of the deceased, physical/literal expressions of yearning, difficulties with separation, feeling of identity disruption

circle of security

how young children organize themselves around their relationships to their caregivers, caregiver acts as a secure base to welcome child back when they need support, but to let them go explore and check in to enjoy things collectively

extremes of insufficient care

social neglect or deprivation, repeated changes in primary caregiver, institutions that limit attachments

reactive attachment disorder

pattern of inhibited, emotionally withdrawn behavior towards adult caregivers manifested by rarely seeking comfort when distressed and minimally responding to comfort when distressed, minimal social and emotional responsiveness to others, limited positive affect, episodes of unexplained irritability or sadness, fearfulness in non-threatening interactions

disinhibited social engagement disorder

pattern of actively approaching and interacting with unfamiliar adults with reduced reticence in approaching, overly familiar verbal or physical behavior, diminished/absent checking back with adult caregiver after venturing away, willingness to go off with unfamiliar adults with no hesitation

onset of attachment disorders

symptoms must be noted before age 5 and have a developmental age of at least 9 months, may persist even if neglect is remedied but caregiving quality does moderate

prevelance of attachment disorders

<10% reactive attachment when exposed to significant neglect, 2% disinhibited social engagement among very low-income communities

risk factors for trauma and stress related disorders

being female, experiencing poverty, parental psychopathology; subjective appraisal of event, lack of social supports, comorbid disorders, multiple exposures

prevalence of trauma event exposure in children

30-60%

prevelance of ptsd

children 21.5%, adolescents 5-8%, adults 6.8%

prevalence of acute stress disorder

trauma exposed children 16.5%, adult non-interpersonal trauma <20%, adult interpersonal trauma 20-50%

trigger warnings

prior notification about forthcoming content that may be emotionally disturbing, intent of preparing individuals who may experience intrusive symptoms after trauma exposure

what are the findings on trigger warnings

increased anticipatory anxiety, may increase distress or persistence of trauma-related symptoms over time

why would there be less concern of parental guidance ratings compared to trigger warnings

meets traditional views about monitoring what kids are viewing, allows caregivers to make choices of children’s exposure

what disruptive/conduct symptoms should be expected of normally developing children

arguing with parents, annoying someone on purpose, taking something that doesn’t belong to you, fighting; majority of children do not engage in any delinquent or antisocial acts during childhood or adolescents

differences between ODD and CD

odd has less severe behaviors and include emotional dysregulation

cd has more severe behaviors and doesn’t include emotional symptoms

similarities between ODD and CD

both defined by severe behaviors, can be comorbid

why isn’t adhd classified as a disruptive/conduct disorder

it is a neurodevelopmental disorder, symptoms manifest early and are associated with developmental deficits

how might clinician bias influence who is diagnosed with ODD, CD or ADHD

ethnic and racialized minority groups more likely to get diagnoses of odd or cd instead of adhd, systemic biases of expectations from groups, limbic reactivity from higher rates of traumatic stress and biological priming, stigma

how long do symptoms persist in operant defiant disorder

6 months, children younger than 5 engage most days of the week, children 5+ at least once per week

operant defiant disorder

angry/irritable mood - often loses temper, easily annoyed, angry/resentful, has been spiteful or vindictive at least twice, argumentative/defiant behavior - argue with authority, refuses to comply with requests, deliberately annoys others, blames others for mistakes

spiteful

mean-spirited actions that do no benefit the actor and may involve disadvantaging the self

vindictive

predisposition towards revenge

how to distinguish irritability in ODD and DMDD

DMDD focuses on tonic and phasic irritability, ODD can involve irritability but also must have one symptoms of argumentative/defiant or vindictiveness

prevalence of ODD

3.3%, 2:1 boys to girls

conduct disorder

pattern of behavior where basic rights of others or major age-appropriate societal norms or rules are violated, 3 symptoms in 12 months with 1 in the last 6 months

destruction of property in CD

deliberately engaged in fire setting with the intention of causing damage, deliberately destroyed others’ property without fire

deceitfulness or theft in CD

broken into home/building/car, lies to obtain goods or favors/avoid obligations, stolen non-trivial items without confrontation

serious violations of rules in CD

before age 13; stay out at night, run away overnight at least twice or once without returning for lengthy period

aggression to people and animals

bullies, threatens or intimidates others, initiates physical fights, used a weapon, physically cruel to others/animals, stolen while confronting, forced sexual activity

onset of CD

late childhood/early adolescence, childhood is 1 symptom before age 10, adolescence is no symptoms before age 10

specifier of limited prosocial emotion in CD

persistent over 12 months, lack of remorse or guilt, lack of empathy, unconcerned about performance, shallow or lack or emotional expression

prevalence of CD

high in males and females, males tend to use more physical aggression, males and females exhibit relational aggression

treatment for externalizing disorders

parent management skills, helps learn right from wrong but may struggle in regulting when parents aren’t around

attention deficit hyperactive disorder

pattern of inattention and/or hyperactivity-impulsivity, 6 or more symptoms unless 17 and older, then 5 symptoms

inattention in adhd

disorganization, difficulty sustaining focus or following instructions, fails to give close attention to details, making careless errors, avoids tasks that require sustained effort, losing necessary items, easily distracted, forgetful

hyperactivity/impulsivity in adhd

excessive motor activity when inappropriate, hasty actions that occur without forethought, fidgety, leaving seat, runs/climbs/restlessness, unable to play quietly, on the go/driven by a motor, talks excessively, blurting, difficulty waiting turn, interrupts

prevalence of adhd

7.2% of children

assessment considerations in odd, cd and adhd

general comorbidity can be expected, consider quality of impulsive behaviors, youths may under report, parents/teachers provide objective reports without intention, behavior may differ across context so multiple informants is important

intermittent explosive disorder

behavioral outbursts representing a failure to control aggressive impulses with little provocation manifested by verbal or physical aggression that does not result in damage/injury twice weekly in 3 months, or three behavioral outbursts involving damage and physical injury

prevalence of intermittent explosive disorder

4%, need developmental age of 6 to meet criteria

pyromania

purposeful fire setting, tension/affective arousal before act, fascination with fire, pleasure or relief during/after act; rare

kleptomania

failure to resist impulses to steal objects that are not needed for personal or monetary use, tension before act, pleasure or relief during/after act; low prevalence

why isn’t kleptomania considered a subtype of OCD

shoplifting is compulsive, not planned, but they’re not stealing to reduce anxiety

what are neurodevelopmental disorders

appear early in development, developmental deficits or differences in brain processes

what areas of communication are impacted in communication disorders

expressive production and receptive understanding

language disorder

difficulties in the acquisition and use of language across modalities due to deficits in comprehension or production; reduced vocabulary, limited sentence structure, impairments in discourse

prevalence and onset of language disorder

onset of difficulties by age 2, prevalence 6-8%

speech sound disorder

difficulty with speech sound production that interferes with verbal communication of messages, impairment in phonological knowledge or articulation (ability to coordinate speech movements with breathing and vocalizing)

childhood onset fluency disorder

disturbances in normal fluency and time patterning of speech; sound and syllable repetition, sound prolongations, broken words, audible or silent blocking, circumlocutions, monosyllabic whole-word repetitions

prevalence of childhood onset fluency disorder

1.5%, occurring before age 6

social (pragmatic) communication disorder

difficulties in social use of verbal and nonverbal communication manifested by deficits in using communication for social purposes, unable to change communication to match context, difficulty following rules for conversation, difficulty understanding what is not explicitly stated

prevalence and onset of social communication disorder

rare before age 4, prevalence not well understood, potential overlap with social anxiety disorder

autism spectrum disorder

deficits in social communication and social interaction, restricted and repetitive patterns of behavior, with or without intellectual impairment, with or without language impairment, symptoms must be present in early development

prevalence and onset of ASD

1-2%, often identified at age 2, 80% heritable

how is neurodiversity similar and different to disability

neurodiversity movement conceptualizes ASD as a manifestation of ordinary variations across humanity, medical model of disability says its caused by disease, social model of disability says its caused by lack of appropriate social accommodation

ASD representation

julia from sesame street, embodied individual differences in ASD, an act of early intervention to teach children

summary of Saleem 2019

racial trauma is a valid and impactful form of trauma for youth, shaped by developmental stage and environmental context, and should be recognized to provide effective care

summarize Courchesne

flexible method that captures autistic youth’s first-person perspectives across a range of communication profiles