PSY exam 2 i think

Intellectual Developmental Disability (IDD)

IQ scores two standard deviations below the mean, significant limitations in adaptive functioning, and onset before age 18.

Mild IDD

IQ of 55 to 70

Represents 85% of people with IDD—the most common

Identified around elementary school years

No organic explanation

Moderate IDD

IQ of 40 to 54

Represents 10% of individuals

Shows delay in early developmental milestones

Severe IDD

IQ of 25 to 39

Represents 4% of individuals

Associated with organic causes

Profound IDD

IQ below 20 or 25

Represents 2% of individuals

Identified in infancy due to delays in development and biological anomalies

Associated with organic causes + co-occurs with severe medical conditions

Organic cause

A clear biological cause

• Genetic disorders, accidents (anoxia), head trauma

• More associated with severe-profound IDD (exception to down-syndrome)

Cultural-familial cause

No organic cause and usually a history of family background, economic deprivaion, inadequate child care, etc.

Treatment for IDD involves:

multi-component, integrated strategy that cosiders children’s needs within context of their:

• individual development

• family and institutional setting

• community

Psychosocial treatments for IDD

Early intervention

ABA

CBT

Family oriented strategies

DEPRESSIVE DISORDERS

EXCESSIVE UNHAPPINESS

(DYSPHORIA) AND LOSS OF INTEREST IN ACTIVITIES

(ANHEDONIA)

Depression as a symptom

Feeling sad or miserable, often without the existence of a serious problem + relatively common in all ages

In children it’s typically temporary, related to evetns in the environment, and not part of any disorder

Depression as a syndrome

A group of symptoms that occur together

Along with sadness, the child may display a reduced interest or pleasure in activities, cognitive and motivational changes, and somatic and psychomotor changes.

often includes mixed symptoms of anxiety and depression

Depression as a disorder

The presence of sad, empty, or irritable mood, along with somatic and cognitive symptoms that interfere with the individual’s functioning

Major Depressive Disorder (MDD)

A form of depressive disorder characterized by five or more mood, cognitive (e.g., indecisiveness, inability to think or concentrate), psychomotor (e.g., agitation or retardation), or somatic (e.g., weight loss, sleep disturbances) symptoms that have been present during the same 2-week period; at least one of the symptoms is either depressed mood most of the day, nearly every day, or markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

Prevelance + comorbidities with MDD

2-8% of children 4-18 experience it

Most common comorbidities include: anxiety disorders, specific phobias, and seperation anxiety disorders

Persistent Depressive Disorder (P-DD)/Dysthymia

A depressive disorder associated with depressed or irritable mood; generally fewer, less severe, but longer-lasting symptoms (a year or more in children) than seen in major depressive disorder (MDD); and significant impairment in functioning.

Prevelance + comorbidities with P-DD

1% of children display + 5% of adolescents display

Most common comorbidities include: anxiety disorders, conduct disorders, adhd

Disruptive Mood Dysregulation Disorder (DMDD)

A DSM-5 depressive disorder characterized by: (1) frequent and severe temper outbursts that are extreme over-reactions to the situation or provocation; and (2) chronic, persistently irritable or angry mood that is present between the severe temper outbursts.

Prevelance + comorbidities with DMDD

Occurs primarily in males + school aged children

Most common comorbidities include: anxiety, mood, and disruptive disorders

How does depression express itself during childhood

Preschoolers: extremely somber + tearful

School-age: increasing irritability, disruptive bx, tantrums, and morbid preoccupations

How does depression express itself in adolescence

Similar symptoms of younger children + self-blame, low self-esteem, persistent sadness, and social inhibition

Gender differences with depression

Boys have more issues with emotional reactivity

Girls self-esteem + how they socialize + body image linked

NOT hormonal

How do mood disorders affect intellectual and academic functioning

• Difficulty concentrating + slowness of thought

• Intereference speed of thought, attention, and cordination

Potential delays/problems with depression

Social withdrawal + ineffective styles of coping in social situations

Selective attentional biases—focusing only on negative thoughts

Low self-esteem

Attachment theory

Focuses on parental separtion and disruption of attachment bond + parents consistent failure to meet child’s needs as predispoding factors for depression

Behavioral + cognitive theories for depression

Related to lack of response-contingent positive reinforcement and focus on relationship between negative thinking and mood

The negative cognitve triad

The person devaules the themselves, the future, and the world

Diathesis-stress model of depression

The impact of stress is moderated by individual risk factors and that the occurrence of depression depends on the interaction between the subject’s personal vulnerability and life stress.

Developmental framework of depression

Multiple pathways

• Genetic

• Family experiences

• life stress

• interpersonal competence

• emotional regulation

• core beliefs about self/others

CBT for depression

Teach youth to identify, challenge, and modify negative thought processes + focus on increasing pleasurable activities/events and give youth skills necessary to obtain more reinforcement

Bipolar Disorder (BP)

A DISTINCT PERIOD OF ABNORMALLY AND PERSISTENTLY ELEVATED, EXPANSIVE, OR IRRITABLE MOOD AND ABNORMALLY AND PERSISTENTLY GOAL-DIRECTED BEHAVIOR OR ENERGY, LASTING AT LEAST 1 WEEK AND PRESENT MOST OF THE DAY, NEARLY EVERY DAY (OR ANY DURATION IF HOSPITALIZATION IS NECESSARY).

Symptoms fo BP

• INFLATED SELF-ESTEEM OR GRANDIOSITY

• DECREASED NEED FOR SLEEP

• MORE TALKATIVE THAN USUAL OR PRESSURED SPEECH

• FLIGHT OF IDEAS OR EXPERIENCING RACING THOUGHTS

• DISTRACTIBILITY, REPORTED OR OBSERVED

• INCREASEE IN GOAL-DIRECTED ACTIVITIES OR PSYCHOMOTOR AGITATION

• EXCESSIVE INVOLVEMENT IN PLEASURABLE ACTIVITIES THAT HAVE A HIGH POTENTIAL FOR PAINFUL CONSEQUENCES

Bipolar I disorder

Mania and depression

Bipolar II disoder

Hypomania and depression

Cyclothymic disorder

Hypomania and milder depression—not as hight or low but dysfunctional

Minimum 1 year of mood swings between hypo and mania

Young people with BP display:

Significant impairment in functiong—hospitalization, MDD, medication, co-occuring disruptive bx, and anxiety disorders

History of psychotic symptoms + suicidal idealion are common

How does BP mania display in youth

Volatile and erratic changes, psychomotor agitation, mental excitation, irritability

Pressures speech, racing thoughts, and flight of ideas as classic symptoms in children

Prevalence of BP

0.5-2.5% of youths 7-21 yrs old experience it

Mild _ II and C_ more likely than _ I

Comorbidty of BP

• Anxiety disorders

• ADHD and oppositional and conduct disorders

• Substance use disorders

• suicidual thoughts and idealation

• Medical problems (cardiovascular and metabolic)

Onset, course, and outcome of BP

60% of patients have first episode prior to 19 yrs

Chronic and resistant to treatment—long-term prognosis is poor

Causes on BP

Most heritable forms—family and gene studies indicate increased risk

Irregularities in multiple brain structures

poor maternal health/nutrition/substance use during pregnancy

parental mood disorders

Treatment for BP

No cure for BP → multimodial plan

• monitoring symptoms

• education for patient and family

• matching treatment to individual

• administering medication

• addressing symptoms and related pscyhosocial impairments with psychotherapeutic interventions

  • provides comping mechanisms + cognitive-behavioral skills

Anxiety

Strong negatice emotions + bodily symptoms of tension in anticipation of future danger

• fight or flight response: physical response to perceived threat

• Future-oriented mood state

Separation Anxiety Disorder (SAD)

Youth displays age-inappropriate, excessive, and disabling anxiety about being apart from his or her parents or away from home.

• recurrent, excessive distress when separation from home or major attachment figure occurs or is anticipated

• persistent & excessive worry about losing, or possible harm befalling a major attachment figure (MAF)

• Persistent and excessive worry about experiencing an untoward event that causes separation from MAF

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

• persistently & excessively fearful or reluctant to be alone or w/out MAF at home or w/out significant adults in other settings

• persistent reluctance or refusal to go to sleep w/out being near a MAF or to sleep away from home

Prevalence + comorbidity for SAD

Occurs in 4-10% of children—more prevalent in girls than boys

Typically develop a depressive disorder

Earliest reported age of onset (7-8 yrs)

Developmental differences in SAD + associated features

Worry is present at all ages but takes different form—child must be nearby MAF (presentation depends on age)

75% show school reluctance/avoidance

Specific phobia

Age-inappropriate persistent, irrational, or exaggerated fear that leads to avoidance of the feared object or event (other than social situations) and causes impairment in normal routine

• Can be expressed by crying, tantrums, freezing, or clinging

• More common in girls

• Co-occurs with anxiety + depression

• onset at 7-9 yrs.

Social Anxiety Disorder

A marked and persistent fear of social or performance requirements that expose the individual to scrutiny and possible embarrassment.

Individual fears that they will act in a way/show anxiety that will be negatively evaluated → avoid any sort of social situation

prevalence + comorbidity + course of social anxiety disorder

Lifetime prevalence of 6-12% of children

2x common in girls

Paired with another anxiety disorder + depression

Selective mutism

Selective settings and with selected people, choose not to speak

following should be considered:

• absence of abnormal neurological exam

• normal hearing

• IQ in normal range

Characteristics include: immature, controlling, and oppositional + vacant, and withdrawn look

prevalence + comorbidity + course of selective mutism

Presents when child first enters school

Age of onset usually 3-5 yrs, can be late as 7 yrs

Slightly more common in girls

Occurs in 0.7% of children

Panic Disorder (PD)

Recurrent unexpected panic attacks for at least 1 month + persistent concern about having another attack and the possible implications and consequences they would bring and a significant maladaptive change in behavior related to these attacks

Agoraphobia

Fear/anxiety in certain places or situations

Fear of being in a situation in which escape or help are not available

Prevalence and comorbidity of PD and agoraphobia

2.5% of teens 13-17 yrs.

More common in adolescent females

Have another anxiety disorder/depression + risk for suicidal behavior

First panic attack 15-19 yrs.

Generalized anxiety disorder (GAD)

Excessive anxiety and worry which is difficult to control

• Restlessness

• Fatigue

• Difficulty concentratin

• Irritability

• Muscle tension

• worry excessively about minor things

Prevalence, comorbidity, onset, course, and outcome for GAD

• National survey: lifetime prevalence rate is 2.2%

• Equally common in boys and girls

• Accompanied by high rates of other anxiety disorders and depression

• Average age of onset is early adolescence

• Older children have more symptoms

• Symptoms persist over time

Obsessive-compulsive Disorder (OCD)

Must include both:

• Obsessions: recurrent and persistent thoughts, urges, images that are intrusive and unwanted and cause anxiety or distress

• Compulsions: repetitive, purposeful, and intentional behaviors or mental acts performed to respond to an obsession

Youth involve family members in rituals

Prevalence and comorbidity

Lifetime prevalence is 1-2.5%

2x common in boys

Common comorbidities include anxiety disorders, ADHD, ODD, and vocal + motor tics

Depression, substnace-use, learning, and eating disorders more common in older children

Onset, course, and outcome

Average age of onset 9-12 yrs.

Young children typically have obsessions that are more vague than those of older children

Chronic disorder: as many as two-thirds continue to have OCD 2 to 14 years after initial diagnosis

Possible dev pathway for anxiety disorders

• Inborn disposition

• Early child rearing environments

• Insecure attachment

• Paretning style

• Psychological vulnerability

• Stressors

• Arousal and avoidance (in absence of threat)

Overview of interventions

Main line of attack for treating anxiety disorders is exposing children to anxiety-producing situations, objects, and occasions in order to modify:

• Distorted information processing

• Physiological reactions to perceived threat

• Sense of a lack of control

• Excessive escape and avoidance behaviors

Systematic desensitization

Start from least to most scariest interaction with fear

Work on coping skills, and then progress with interactions and work upwards

Flooding

Going straight into scariest interaction with fear after prep work

Response prevention

Expose person to fear but deny them engaging in escape/avoidance; break compulsion

Modeling and reinforce practice

Model behavior for person with phobia/anxiety so that they can model afterwards

CBT for anxiety disorders

• addresses the irrational thoughts about fear/anxiety

• builds skills (social skills, problem solving skills) to build self efficacy, assertiveness

• Coping Cat: decrease negative thinking, increase active problem solving, and a functional coping outlook

• relaxation

• exposure

• generalization/maintenance

Family interventions for anxiety disorders

Greater parental involvement

Modeling and reinforcing coping techniques

Inclusion of parental anxiety-management strategies

Inclusion of parent skills training

Family treatment for OCD

Provides education about the disorder

Helps families cope with their feelings