Child Psych Exam

OCD Onset

age 9-12

2 peaks in early child hood

2/3 continue long term

OCD impacts what?

Disrups social, family and school

Why does OCD have these impacts?

Time-consuming compulsions (>1 hr/day)

Intrusive thoughts → poor concentration

Perfectionism → avoidance

Cognitive overload

Shame → depression

What is an obsession

= intrusive thoughts

Contamination

Symmetry

Harm thoughts

Sexual/religious (VERY testable)

What are compulsions

= repetitive behaviors

Cleaning

Checking

Counting

Arranging

Reassurance checking

Intrusive thoughts

Not wanted aka egodystonic

Cause stress/anxiety
Lead to compulsive avoidance to reduce anxiety
interrupt on-going activity

Comorbidity in OCD

Cormorbid disorders occur in approximately 50-70% of children 

Most common:

ADHD

ODD

Vocal and motor tics disorders 

Learning disorders 

Eating disorders 

Depression 

Substance use disorders

OCD Treatment

CBT

Exposure and response prevention (ERP) repeatedly triggering the child’s obsessions (exposure) and helping them to resist the compulsions over a series of exposures 

Must be done in a developmentally appropriate manner 

Four types of neglect

1. Neglect 

2. Physical abuse 

3. Sexual abuse

4. Psychological abuse 

Types of psychological abuse

Spurning (rejecting)

Isolating

Exploiting

Ignoring

Terrorizing

Poly victimization

Multiple types of abuse

Occurs during transitions (ex moving allows for new environment, less super vision and more help needed)

Trauma Types

Discrete = one event

Complex = more than one

PTSD in Kids

Omen formation (“I should’ve known”)

Time skew (wrong sequence)

Reenactment play

Nightmares

ACE’S (adverse childhood experience)

High ACE = HUGE suicide risk

7+ ACEs → 30–50x increase

Autism spectrum disorder (ASD)

• Social communication deficits

• Restricted/repetitive behaviors

Early signs of ASD

Poor eye contact

No joint attention

Language delays

ASD can show unique skills called…

Savant = exceptional ability

Splinter = narrow skill

ABA Principles

Behavior shaped by environment

Reinforcement-based

Childhood Schizophrenia symptoms

Positive: hallucinations delusions

Negative: flat affect, Disorganized speech

How common is childhood schizophrenia

Rare (<13 yrs = VERY rare)

Course for schizophrenia

Prodromal → Acute → Residual

Schizophrenia causes

Strong genetics (~80%)

Dopamine dysfunction

Neurodevelopmental model