PSYC 434 Exam #3 Flashcards

Chapters 9-11

conduct problems

wide range of age-inappropriate actions and attitudes of a child that violate family expectations, societal norms, and personal or property rights of others.

ranges from disruptive and rule-violation to extreme antisocial behavior

anti-social personality disorder

people who have no care for other people’s rights

relationship between ASPD and conduct problems

not every child with conduct problems grows up to have anti-social personality disorder

every adult with anti-social personality disorder has conduct problems as a child

oppositional defiant disorder (ODD)

rule out conduct disorder first

pattern of negativistic, hostile, and defiant behavior lasting at least 6 months during which four or more of the following:

• angry/irritable mood

  • often loses temper

  • is often touchy/easily annoyed

  • is often angry/resentful

• argumentative/defiant behavior (argue for sake of arguing)

  • often argues with authority figures (adults)

  • often actively defies or refuses to comply with requests from authority figures or with rules

  • often deliberately annoys others

  • often blames others for their mistakes/misbehaviors

• vindictiveness (revenge towards others)

  • has been spiteful or vindictive at least within past 2 months

• disturbance in behavior is associated with distress in individual or others in social context, or impacts negatively on social, academic, or occupational functioning

• behaviors do not occur exclusively during course of another disorder

conduct disorder

repetitive and persistent pattern of behavior in

• aggression to people and/or animals (unprovoked)

• has been physically cruel to people and animals

• has stolen while confronting a victim

• has forced someone into sexual activity

• destruction of property

• deceitfulness/theft

• serious violation of rules

disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning

if the individual is 18 years or older,…

criteria is not meant for Antisocial Personality Disorder

childhood-onset of conduct disorder

more linked to continued antisocial behavior and more common in boys

adolescent-onset of conduct disorder

equally likely in boys and girls, less violent, psychopath behavior

cognitive and verbal deficits of those with conduct disorder?

slightly lower IQ than peers

verbal IQ consistently lower than performance IQ

school and learning problems of those with conduct disorder?

academic problems

under achievement

suspension

expulsion

peer and family problems of those with conduct disorder?

verbal and physical aggressiveness towards peers

poor social skills

rejected by peers

more likely to become involved with deviant peers

hostile-attributional bias: more likely to attribute negative intent to other children, especially when intentions are unclear

high levels of family conflict

harsh punishment

health issues of those with conduct disorder?

engage in behaviors that put them at risk for

• injuries, overdoses, STDs, substance abuse, premature death

cause of ODD and CD

life-course-persistent (LCP) path and adolescent-limited (AL) path

life-course-persistent (LCP) path

children who engage in aggression and antisocial behavior at an early age and continue to do so into adulthood

adolescent-limited (AL) path

antisocial behavior begins in puberty, persists through adolescence and ceases into young adulthood

gender differences in ODD and CD

more common in boys, especially in childhood (10x more likely, and more chronic)

• 2x more likely in adolescence

anti-social girls display less violence

boys are more likely to engage in repeated acts of violence

why the gender differences in ODD and CD?

girls are more likely to use relational aggression (spreading rumors, withholding friendships, etc.)

• more covert

boys are more likely to engage in physical aggression

some question whether criteria should be modified for girls

genetic factors contributing to conduct problems

approx. 50% of variance accounted for by genetics

• low MAOA - related to ability inhibit aggression

strength higher for those with LCP pattern

criminology and pathology tend to run in families

prenatal and birth complications contributing to conduct problems

low birth weight

malnutrition during pregnancy

pre-natal substance use

difficult to disentangle genetics and environment

neurobiological factors contributing to conduct problems

overactive BAS and underactive BIS

heightened sensitivity to rewards and fail to respond to punishment/continue to respond under conditions of no reward

HPA axis and ANS (low arousal and low autonomic reactivity)

BAS (behavioral activation system)

stimulation of behaviors in response to signals of reward or lack of punishment

BIS (behavioral inhibition system)

production of anxiety and inhibition of ongoing behavior in presence of novel events, innate fear stimuli, and signals of nonreward/punishment

social-cognitive factors contributing to conduct problems

inability to use verbal mediators

immature forms of thinking

• egocentrism

• lack of social perspective, theory of mind deficits

• moral reasoning deficits

family factors contributing to conduct problems?

reciprocal influence

harsh punishment

attachment problems

media factors contributing to conduct disorders

exposure to media may reinforce pre-existing tendencies in certain children

long term studies show:

• exposure to violence between 6 and 9

• identification with aggressive TV characters

• perceived realism of media violence

cultural factors contributing to conduct disorders

rates vary across cultures

may depend on what types of behaviors are valued

Kapaku of Western New Guinea - homicide rates more than 40%

treatment of conduct disorders

very difficult to treat, treatment approaches differ depending on age of child

early interventions/prevention programs - young children just starting to display problem behaviors

ongoing interventions - help older youth and families cope with associated academic, emotional, and social problems

parent management training

assumption that maladaptive parent-child interactions are at least partly responsible for producing and maintaining behavior

problem-solving skills training

helps child think through actions and handle social situations

multisystemic treatment

intensive family and community-based approach for adolescents with severe conduct problems

focuses on interconnected social system: family, social, neighborhood, court/juvenile systems

combination of PMT, PSST, marital therapy, special education, substance abuse treatment or legal services

prevention of conduct disorders

most effective in younger children

can limit or prevent future and more serious symptoms

mood disorders

disturbance in mood is central feature

suffer from extreme, persistent, or poorly regulated emotional states

depression one of most common disorders in children and adolescents

how is depression different in children?

originally thought it didn’t exist in children

children experience depression differently as they age

individual differences

normative behaviors

major depressive disorder

five (or more) symptoms have been present during same 2-week period and represent change from functioning; at least one of symptoms is either depressed mood or loss of interest or pleasure:

• depressed mood

• loss of interest

• significant weight loss/gain

• insomnia/hypersomnia

• psychomotor agitation/retardation

• fatigue/loss of energy

• feelings of worthessness/excessive/inappropriate guilt

• diminished ability to think/concentrate/indecisiveness

• recurrent thoughts of death, recurrent suical ideation without a specific plan, or suicide attempt, or specific plan for committing suicide

these symptoms cause clinically significant distress or impairment in important areas of functioning

comorbid diagnoses of depression?

anxiety

conduct problems

ADHD

substance abuse

gender differences in depression?

girls are 2x more likely to develop depression

girls more likely to report fearfulness, feelings of inadequacy, negative self-evaluation, and negative self-affect as children

racial differences in depression?

nonwhite youth higher rates than White youth

likely due to socioeconomic status

increased vulnerability to stress

persistent depressive disorder (dysthymic disorder)

depressed mood for most of day, for more days than not as indicated either by subjective account/observation by others for at least 1 year

children are often irritable

less severe than MDD

more chronic

more common than MDD

associated characteristics and risk factors for depression

genetics

serotonin and norepinephrine

emotion regulation

cognitive factors

• information-processing biases - negative automatic thoughts

• negative cognitive triad (devalue world, self, and future) - leads to negative schemas

Beck’s Cognitive Theory of Depression

less supportive

stressful life events

social media

treatment for depression

antidepressants (most common, side effects can cause suicidal ideation)

• SSRIs (selective serotonin reuptake inhibitors)

cognitive therapy (challenging irrational beliefs)

• child has to be at least 7

behavioral therapy (increase pleasurable events and activities in child’s life, provide children with skills to obtain reinforcement)

CBT - most effective

bipolar disorder

originally thought to be an adult disorder

bipolar I disorder

at least one manic episode

often also experience depressive episode(s)

manic episode

distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)

during period of mood disturbance, 3 (or more) of following symptoms have persisted (4 if mood is only irritable) and have been present to significant degree:

• inflated self-esteem or grandiosity

• decreased need for sleep

• more talkative than usual or pressure to keep talking

• flight of ideas or subjective experience that thoughts are racing

• distractibility

• increase in goal-directed activity (either socially, at work, or school, or sexually) or psychomotor agitation

bipolar II disorder

hypomanic episodes and major depressive episodes

hypomania

distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non-depressed mood

less severe than mania

bipolar disorders

less likely to be diagnosed in prepubertal children

children are more likely to be irritable than elated

equally likely to be diagnosed in boys and girls

common comorbid disorders: ADHD, conduct problems, anxiety disorders, substance use

factors contributing to bipolar disorder

few studies have examined the causes of bipolar disorder in children and adolescents

is result of genetic vulnerability in combination with environmental factors (e.g., life stress, family disturbances)

one of most heritable forms of mental disorders

treatment of bipolar disorders

no cure

treatment usually stabilizes mood and allows for management and control of symptoms

multimodal treatment plan of bipolar disorders

close monitoring of symptoms

education

medication (lithium #1)

• not used in children under age of 12

psychotherapeutic interventions to address symptoms and related psychosocial impairments (communication and emotion regulation, problem solving, CBT)

normal anxiety

fight or flight response, body is designed to have this

comes with physical symptoms (palms are sweaty, heart racing, short of breath)

cognitive symptoms (feeling numb, racing thoughts)

behavioral symptoms

fear, anxiety, and worry aretypical in children and changes with age

anxiety disorders

internalizing disorders

persistent and distressing anxiety

interferes with normal functioning

inconsistent with developmental level

some anxiety is good

generalized anxiety disorder

excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities, person finds it difficult to control the worry

anxiety and worry are associated with three or more of following symptom (only one is required in children)

• restlessness or feeling keyed up or on edge

• being easily fatigued

• difficulty concentrating or mind going blank

• irritability

• muscle tension

• sleep disruption

anxiety does not focus on specific object or situation but rather many different things

tend to expect the worst

underestimate ability to cope with situations or events that are less than ideal

worry about major catastrophic events and minor everyday occurences

self-conscious, self-doubting, worried about meeting others’ expectations

constantly seek approval from adults

highly self-critical

interpersonal problems

gender differences in anxiety?

3-6% of all children

equal in boys and girls

• slightly higher in older adolescent girls

comorbidity of anxiety?

more likely, average age of onset 10-14 years old

separation anxiety disorder

development of inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached (must have 3 or more of the following)

• recurrent excessive distress when separation from home/major attachment figures is anticipated

• persistent/excessive worry about losing/possible harm befalling major attachment figures

• persistent and excessive worry that an event will lead to separation from major attachment figure

• persistent reluctance or refusal to go to school/elsewhere because of fear of separation

• persistent and excessively fearful/reluctant to be alone/without major attachment figures at home/without significant adults in other setting

• persistent reluctance/refusal to sleep without being near major attachment figure/ to sleep away from home

• repeated nightmares involving theme of separation

• repeated complaints of physical symptoms when separation of attachment figures occurs/is anticipated

duration of disturbance is at least 4 weeks

typicality of separation anxiety disorder?

in children

7 months - preschool years, most children experience separation anxiety to some degree

some children continue to display age-inappropriate separation anxiety

excessive demands for parental attention

often engage in behaviors designed to avoid separation (school reluctance and refusal very common)

can also occur with children not diagnosed with separation anxiety disorder

one of the most common disorder(s) in childhood?

separation anxiety disorder

specific phobia

gender differences and comorbidity of separation anxiety disorder?

more prevalent in girls

most have anxiety as comorbid

high risk for developing depressive disorders

tends to be reported at early age (7 or 8 ears)

may occur after stressful event (sickness, COVID, etc.,)

specific phobia

marked fear or anxiety about specific object or situation (in children: the fear/anxiety may be expressed by crying, tantrums, freezing, or clinging)

the phobic object/situation almost always provokes fear/anxiety

phobic object/situation is actively avoided/endured with intense fear/anxiety

fear/anxiety is out of proportion to actual danger proposed by specific object/situation and to sociocultural context

main types of specific phobias?

natural environment (heights, water, etc,)

animals

blood-injection injury (MOST COMMON HEREDITARY phobia)

situational (crowds, etc.,)

lifetime prevalence and gender differences in phobia?

4-10% lifetime prevalence

most common in childhood (not taken in for treatment most of time)

more common in girls than boys

majority of children not referred for treatment unless phobia has significant impact on sleep/on child’s day

eventually grow out of it

comorbidity of specific phobias?

lower than other anxiety disorders

those with comorbid disorders tend to have other anxiety disorders

social anxiety disorder (aka social phobia)

marked and persistent fear of one or more social/performance situations in which person is exposed to possible scrutiny by others (ex: social interactions, being observed, performing in front of others, PUBLIC SPEAKING is highest), in children, anxiety must occur in peer settings, not just interactions with adults

individual fears that they will act in a way/show anxiety symptoms that will be negatively evaluated

social situations are almost always provoking fear/anxiety

social situations are avoided/endured with intense anxiety/distress

fear/anxiety is out of proportion to actual danger posed by social situation and to sociocultural context

fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more

prevalence and gender differences in social anxiety disorder?

1-3% of children and adolescents (less common than specific phobias and separation anxiety disorder)

more common in girls

what is different about social anxiety disorder?

highly emotional, social fearful and inhibited, sad and lonely

• want to make friends but are fearful

comorbidity of social anxiety disorder?

with other anxiety disorders is high

selective mutism

speak at home but in public completely quiet (even when teacher calls on them just out of fear being perceived differently)

when is social anxiety disorder developed?

developed after puberty

rare in children under age of 10

most children don’t worry about peers that much

obsessive-compulsive disorders

recurrent obsessions, compulsions, or both

obsessions or compulsions are time consuming (take more than 1 hour a day), or cause significant distress or impairment in social, occupational, other important areas of functioning

obsessions

recurrent and persistent thoughts, impulses, or images that are experienced at some time during disturbance, as intrusive and inappropriate and that cause marked anxiety or distress

person attempts to ignore/suppress such thoughts, impulses, or images or to neutralize them with some other thought/action (compulsions)

compulsions

repetivie behaviors (e.g., handwashing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to in response to an obsession or according to rules that must be applied rigidly

behaviors or mental acts are aimed at preventing/reducing distress or preventing some dreaded event/situaiton (obsession)

• these behaviors or mental acts either are not connected in a realistic way with what they were designed to neutralize/prevent/are clearly excessive

  • young children might not be able to articulate aims of behavior or mental acts (try to stop, feel extreme anxiety)

prevalence of children with OCD?

2-3% of children and adolescents diagnosed with OCD

younger children, 2x more common in boys (only one more common in boys compared to girls)

• strong genetic component for OCD

comorbidity of OCD?

anxiety, depressive disorders, and disruptive behavior disorders (conduct disorder & adhd)

age of onset for OCD?

9-12 years, but can happen at any age

younger children with OCD more likely to have family member with OCD

likely to continue into adulthood (EARLY INTERVENTION IS IMPORTANT)

associated characteristics of anxiety disorders

academic performance is impaired (spending so much time thinking/obsessing/engaging in rituals so they are unable to get work done)

associated characteristics of cognitive distturbances

threat-related attentional biases: selectively attend to information that may be potentially threatening/dangerous (assuming the worst)

cognitive biases in cognitive disturbances

maximize negative, minimize positive

behavioral inhibition

tendency to be fearful and anxious, overexcited and withdrawn in response to novel stimuli

external locus of control

things you don’t have control

physical symptoms of anxiety disorders

headaches

stomaches

sleep problems

may increase long-term risk of health problems

social and emotional deficits of those with anxiety disorders

difficulties with relationships with peers

low self-esteem

loneliness

depression

gender differences in anxiety?

by age 6, twice as many girls have experienced anxiety compared to boys

this continues through development

reflated to genetics and social factors

ethnic and cultural differences in anxiety

not much racial differences

ethnic differences in treatment seeking behaviors

• underrepresentation of minority groups in treatment/therapy field

• some minority groups more likely to talk to pastor vs. clinician

development of fears seems to be similar across cultures

anxiety is higher in cultures that promote group harmony

early theories of anxiety development

psychoanalytic theory: anxiety is defense against unconscious conflicts

behavioral/learning theory: two-factor theory (classical and operant conditioning)

attachment theory: fearfulness is biologically rooted in infant’s need for survival

genetics of anxiety development

combination of biological and environmental influences

twin studies - 33% of variance in childhood anxiety is accounted for by genetic influences

variants in genes related to serotonin may be associated with behavioral inhibition and anxiety symptomatology

pretty comorbid with depression

family factors of anxiety disorders

parenting factors - rejection, overcontrol, overprotection

modeling of anxious behaviors

pharmacological treatment of anxiety disorders

adults: benzodiazepines (very addictive)

children: SSRIs (also for mood disorders)

• most effective in treating OCD in combination with psychotherapy

• also somewhat effective in treating GAD, SAD, and social phobia

• therapy should ALWAYS be FIRST choice in treating children

behavior therapy of anxiety disorders

most effective treatment for phobias

exposure: expose child to feared object/situation and provide them with ways of coping other than escape and avoidance (aka exposure with response prevention)

two types of exposure?

graded exposure (systematic desensitization) - gradually expose child to their fear

flooding - expose child to fear all at once

cognitive behavioral therapy

focus on correcting distorted beliefs and underlying cognition that contribute to anxiety

behavioral techniques

this is not effective in very young children (under age 7)