PSYC 2011 GW Final

finals

How to assess mental disorders

Understand normal child development. Some symptoms of disorders differ between children and adults. Clinicians factor in child age, developmental level, and environmental factors.

Why is it harder to understand childhood disorders?

It's hard to differentiate real psychological issues from developmental lags. Kids have a limited ability to discuss their issues. Kids may only have issues in specific contexts.

How many children suffer from psych problems?

18%

3 Developmental Disorders

Pervasive Developmental Disorders, Intellectual Development Disorder, Specific Learning Problems

3 Disruptive Disorders

ADHD, Conduct Disorders, Oppositional Defiant Disorder

3 Emotional Disorders

Separation Anxiety, Childhood Depression, Phobias

Eating & Habit Disorders

Anorexia, Bulimia, Tic Disorders, Elimination Disorders

3 characteristics of intellectual disability

Deficits in Intellectual Functions, Impaired Adaptive Functioning, Onset Before 18

Deficits in intellectual functions

Reasoning, problem solving, planning, abstract thinking, academic learning, experiential learning

Impaired adaptive thinking

Communication, self care, use of community resources, health/safety

4 Intellectual Disabilities

Intermittent, Limited, Extensive, Pervasive

Intermittent

Need some support for some tasks

Limited

Need more consistent support for challenging activities

Extensive

Need support for daily care

Pervasive

Need constant care

Etiologies of Intellectual Disabilities

Chromosomal abnormalities, teratogens, brain development, environment

Chromosomal abnormalities

a deficiency or excess of one or more chromosomes (Down's Syndrome: Extra chromosome at 21st chromosome)

Teratogens

FAS; baby exposed to toxic stuff

Brain Development

Induction defects (closure of neural tube) and migration defects (cell growth issues b/w 2nd & 5th months)

Environment

Limited stimulation and accidents

Autism Spectrum Disorder Demographics

1/68 people, all groups, more common in boys, in childhood

Is ASD prognosis consistent?

No! Most children retain diagnosis and require support throughout their lifetime

ASD prognosis and milder symptoms

Allow for self-sufficiency and successful employment. However, people may retain social awkwardness, restrictive interests, or atypical behaviors.

Is intervention efficient for ASD prognosis?

Yes! Individualized, intense early intervention is needed

Autism Impairments

Social interactions, verbal or nonverbal communication, activities

Social interactions with autism

Unresponsive and aloof, prefer objects over people, show little interest in developing relationships, imitate others, bizarre behavior, repetitive, resist changes in environment

Verbal and nonverbal communication with autism

Lack of communication, echolalia, pronominal reversal, no initiation of conversations, splinter skills, savants

Echolalia

Echo what is said

Pronominal Reversal

referring to yourself in the second or third person, often associated with children and autism (confusion of pronouns)

Splinter Skills

abilities much higher than expected on the basis of their general intelligence, good skills in 1+ areas

Savants

people of low intelligence who have an extraordinary ability

Activities of Autism

Unusual behaviors, strange vocalizations, stare, little imaginative play

Biomedical treatment for autism

Neuroleptics, SSRIs

Neuroleptics

Reduce withdrawal, hyperactivity, and stereotypical movements

SSRIs

Help with anxiety, repetitive behaviors, and expressive language

Behavior modification for autism

Decreased self-mutilation, self-stimulation, echolalia, increased attention, verbal behaviors

Learning Disorders Overview

Poor school performance in reading, math, or written expression; large gap between potential and achievement

LD 1: Dyslexia

Trouble with reading and spelling

LD 2: Dyscalculia

Trouble with math

LD 3: Dysgraphia

Trouble with written expression

ADHD Overview

Inattention and hyperactivity (or impulsivity)

ADHD Demographics

5-12% of children, 4-6x more common in boys, all cultures, most common childhood disorder

Inattention

Inability to pay attention, listen, follow instructions, complete tasks,

Hyperactive-Impulsive

quick, restless, and frequent movements; vigorous bursts of locomotion

ADHD Diagnostic Criteria

Onset before age 12, Impairment in many settings, inattention

Which co-morbid illness do kids have?

CD/ODD

Psycho-Stimulants for ADHD

Enhance dopamine and norepinephrine, increase attention, decrease impulsivity, enhance productivity, improve social skills

Side effects of psycho-stimulants

Insomnia, nausea, weight loss, stomach pains, decrease height, drug dependence

Behavioral treatments for ADHD

Time out, response cost, contingency management to reinforce appropriate behaviors

CBT for ADHD

Enhance problem-solving and social skills but not as effective

Multimodal treatment for ADHD

Combination of behavioral treatment and meds

Conduct Disorder Overview

Aggression, destruction of property, deceit and theft, violate all rules (3+ and older)

Conduct Disorder Onset

Childhood (under 10), adolescent (10+) or unspecified

Oppositional Defiant Disorder

Lose temper, argue with adults, defy rules, annoy others, no responsibility, always annoyed, angry, spiteful

Age for ODD

4+

Age for CD

3+

Treatment for CD and ODD

CBT and Parent Management Training

CBT for CD/ODD

Social skills training, role-playing by videotapes, learn to identify problem behaviors and find solutions for better behaviors

Parent management training for CD/ODD

Help parents establish appropriate limits, give consequences, reward appropriate behaviors

Separation Anxiety Disorder

a disorder marked by excessive anxiety, even panic, whenever the person is separated from home, a parent, or another attachment figure

Symptoms of Separation Anxiety Disorder

Recurrent distress when separated, persistent worry about loss of loved one, reluctance to go to school, afraid to be alone without a love one nearby, afraid to go to sleep without a loved one at home, nightmares or complaints when separated

How long does SAD occur for?

4+ weeks

Motor Disorders

Tics: involuntary movements

3 Motor Disorders

Transient, Chronic, Tourette's

Transient Tics

Less than a year: blinking, foot tapping, coughing, grunting, etc. Chronic disorder is just when this happens for over a year.

Tourette's Disorder

extreme tic disorder involving uncontrollable multiple motor and vocal patterns

Prevalence of Tourette's

Onset before 18, present for at least 1 year

Chances of Tourette's

Rare, more common in boys, runs in families

What is Tourette's co-morbid with?

ADHD

Ways to help Tourette's

Haldol, Clonodine, Social skills training

Elimination Disorders

Enuresis & Encopresis

Enuresis

Unable to voluntarily control bladder by age 5, night wetting, 2 episodes a week for 3+ months!!!

Enuresis Chances

7% boys and 3% girls, impaired social relations, runs in families (75%)

Enuresis Treatments

Medication and Behavioral

Medication for Enuresis

Decrease Stage 4 sleep, decrease urine volume

Behavioral Treatment for Enuresis

Positive reinforcement for appropriate toileting, awaken child to go to bathroom, clean up bed when accidents occur, bedtime urine alarm

Encopresis

Constant defecation

Timing of Encopresis

At least once a month for 3 months and 4 years old

Encopresis Chancing

1% of school-aged kids, more common in boys, more common with constipation

Encopresis Effects

Poor self-esteem, angry relations, rejection

Encopresis Treatment

Physical evaluation, parenting skills training, behavior modification

Obesity

BMI > 30. 2nd cause of death and disease. Unrecognized by DSM 5. Affects more girls.

Obesity Diseases

Hypertension, Dyslipidemia, Type 2 Diabetes, Coronary Heart Disease, Stroke, Gallbladder Disease, Osteoarthritis, Sleep Apnea, Cancer

Obesity Treatments

Dieting, lifestyle changes, medication, surgery, intervention programs (best)

3 EDs

Anorexia nervosa, bulimia nervosa, binge-eating disorder

ED Onset

Adolescence, Chronic, Intermittent course

ED Prevalence

0.09% anorexia, 1-2% bulimia, 2-4% BED - more common in women and athletes but same across all races

Anorexia Nervosa

Problem maintaining body weight at or above the standard, fear of gaining weight or becoming fat, disturbed body image, amenorrhea

2 Types of AN

Restricting & Binging/Purging

Emotional Symptoms of AN

Concern about body image, depression, ritualistic, perfectionist, controlling, resist change

Physical Symptoms of AN

Dry skin, lanugos, sensitivity to cold, enlarged salivary glands, erosion of tooth enamel, potassium depletion, cardiac arrhythmia

Bulimia Nervosa

Recurrent episodes of binge eating, engage in behaviors to prevent weight gain, distorted body image, rigid cognitive style, upset despite being a normal weight

BN Timing

Once a week for 3 months

BN Onset

Late adolescence to early adulthood

BN co-morbidity

Depression and substance abuse

BN Symptoms

Laxative dependent, dental problems, erosion of esophagus

Binge Eating Disorder

Binge-eating within obese ppl, eat alone, feel disgusted while eating, always eat large amounts

BED Timing

Once a week for 3 months

Biological Dimensions of EDs

Moderate heritability, pubertal weight gain, appetitive neural circuitry, dopamine, ghrelin and leptin

Psychological Dimensions of EDs

Body image dissatisfaction, low-self esteem, low self-control, perfectionism, childhood sexual or physical abuse