Child Psych Powerpoints Exam 2

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66 Terms

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Risk assessment

is this person at risk to hurt themselves or other people?

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short term goals

stabilization, barriers to care

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long term goals

“magic wand”

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clinical intervention

  1. risk assessment

  2. short term goals

  3. long term goals

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risk factors for suicide

gender, age, depression/hopelessness, prior SI/SA, exposure to suicide, neglect/abuse/trauma, substance use/abuse, prolonged stress, non-heterosexual orientation, non-suicidal self injury, access to lethal means

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how do we directly assess suicide risk?

three factors

  1. ideation - passive, active

  2. plan

  3. intent

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safety planning

collaboratively generate coping strategies to manage suicidal and self-harm impulses

includes: actions/behaviors, thoughts, supportive individuals

builds hope

it is a process!

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barriers to using safety planning

too distressed to use it

didn’t remember to use it

started to use it but it didn’t work

didn’t want to use it

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obtain commitment to safety

work with client to commit to using safety plan for a specified period of time

if client is unable to give any commitment, assess need for stepped-up care

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restricting access to lethal means

review availability of all lethal means (guns, medications, sharps, others specific to patient)

lethal means available = greater danger

means restriction saves lives

puts “time” between lethal “urge” and ability to act on “urge”

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substance use/abuse and suicide

avoid during time of crisis

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suicide warning signs

change in behavior or the presence of entirely new behaviors

particularly in relation to a painful event, loss, or change

changes in what person says, does, and their mood

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unipolar depressive disorders

only depressive episodes

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bipolar depressive disorders

manic and depressive episodes

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episode

a time-limited period during which specific symptoms of a disorder are present

clinician will rate severity, note whether it is first episode or recurrence, and specify nature of symptoms

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depressive episode

5 or more symptoms, nearly every day, lasts at least 2 weeks

*mood - depressed or irritable

*anhedonia

changes in eating/weight

changes in sleep

fatigue

low self-worth/guilt

lack of concentration/indecisiveness

thoughts of death or suicide

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depression in preschoolers

may appear extremely somber and tearful, lacking exuberance, bounce, and enthusiasm; may display excessive clinging and whiny behavior around parents and fear of separation or abandonment; irritability

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depression in school-aged children

increasing irritability, disruptive behavior, tantrums, and combativeness

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depression in preteens

self-blame and low self-esteem, persistent sadness, and social inhibition

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major depression

a pervasive unhappy mood disorder, more severe than the occasional blues or mood swings everyone experiences

10-20% of individuals experience significant depression at some time; 2-8% of children

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disruptive mood dysregulation disorder

a chronic, severe persistent irritability

two main clinical features:

  1. frequent verbal or physical temper outbursts

  2. chronic, persistently irritable or angry mood

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controversy about DMDD

new diagnosis, so minimal research

not enough published validity studies

extremely high co-occurrence with other disorders

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Beck’s cognitive triad

negative view of

  1. the self

  2. the world

  3. the future

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Lewinsohn’s Behavioral View of Depression

  1. stressor leads to reduction in reinforcers

  2. person withdraws

  3. reinforcers further reduced

  4. more withdrawal and depression

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behavioral activation/activity scheduling

a method for introducing mood-elevating activities into the youth’s day

improves mood by having youth select and regularly engage in activities that are fun, enjoyable and rewarding

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activity selection essentials

connect doing and feeling

make a list

pick things and try them

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CBT for depression

start with mood tracking

identify behaviors that impact mood

positive activity scheduling

teach cognitive restructuring

teach additional skills as needed

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support networking

a set of strategies intended to connect individuals or families with other people

it increases access to resources and social supports

identify others who can provide resources/support AND develop skills to ask for support and to involve others when they need help

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emotional support

showing empathy, compassion, warmth, and concern within the context of a trusting relationship

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companionship support

provision of a sense of belonging

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informational support

provision of advice or guidance

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instrumental support

provision of concrete support in the form of money, materials, or services

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effective support networking

expanding the network of immigrant families

connecting family without transportation to others who can provide a ride

connecting family seeking special education with other parents

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ineffective support networking

case management

group therapy

spending time with others

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support networking essentials

identify allies

recruit allies

promote commitment from allies

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CBT-I (CBT for insomnia)

  1. restrict time in bed (temporarily)

  2. get up at the same time everyday

  3. don’t go to bed unless you’re sleepy

  4. don’t stay in bed unless you’re asleep

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anxiety disorders are characterized by:

experience of physiological arousal

apprehension or feelings of dread

hypervigilance

sometimes a specific fear or phobia

some form of avoidance

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tripartite model of anxiety

physiological responses

cognitive responses

overt behavioral responses

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worry

thoughts about possible negative outcomes that are intrusive and difficult to control

considered a cognitive component of anxiety

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OCD

an anxiety disorder characterized by recurrent obsessions OR compulsions that are inordinately time-consuming or that cause significant distress or impairment

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obsession

a persistent and intrusive idea, thought, impulse, or image

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compulsion

a repetitive and seemingly purposeful behavior performed in response to uncontrollable urges or according to a ritualistic or stereotyped set of rules

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obsessions consist most often of:

contamination fears

fears of harming oneself or others

lack of symmetry

pathological doubt

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compulsions can include:

cleaning

checking

repeating

ordering/arranging

counting

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steps to exposure

key is to identify feared stimuli and reduce unhelpful conditioned responses

  1. learn to rate anxiety

  2. create fear hierarchy

  3. rate SUDs

  4. learn relaxation techniques - controversial

  5. work way up hierarchy

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trauma - general definition

results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being

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acute trauma

single event

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chronic trauma

repeated and prolonged

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complex trauma

exposure to multiple traumatic events from an early age, often within the caregiving system or without adequate adult support that has short and long-term effects in many areas

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racial trauma

experiences related to racism, racial discrimination, and race-related stressors, and can refer to a specific incident of racial discrimination or the ongoing, harmful emotional impact of racial discrimination that builds up over time

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historical trauma

shared by a group of people within a society, or even by an entire community, ethnic, or national group

experienced by oppressed communities over generations

three criteria:

  1. widespread effects

  2. results in distress and collective loss

  3. purposeful, often destructive, intent

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impact of trauma

emotional reactions

psychological and cognitive reactions

behavioral and physical reactions

beliefs

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DSM definition of trauma - PTSD

A. person must have exposure to actual or threatened death, serious injury, or sexual violence

direct experience, witnessing directly, learning the event happened to someone else, repeated extreme exposure

B. reliving the experience

C. avoidance of trauma-related stimuli

D. negative thoughts and feelings

E. trauma-related arousal or reactivity

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core components of child trauma treatment

reestablishing physical and psychological safety

involvement of parents or caregivers

creating a narrative or story about what happened

correcting untrue or distorted ideas about what happened

teaching stress management and relaxation skills

exposure strategies

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reasons to directly discuss traumatic events

gain mastery over trauma reminders

resolve avoidance symptoms

correction of distorted cognitions

model adaptive coping

identify and prepare for trauma/loss reminders

contextualize traumatic experiences into life

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in vivo mastery of trauma reminders

mastery of trauma reminders is critical for resuming normal developmental trajectory

to be used only if the feared reminder is no longer dangerous

hierarchical exposure to innocuous reminders which have been paired with the traumatic experience

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RAD and DSED

used to be one disorder

diagnosed between 9 months and 5 years

occur in extremely neglected and deprived children

extremely rare

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awareness - trauma-informed care

everyone understands the impact of trauma

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safety - trauma-informed care

ensuring physical and emotional safety

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trustworthiness - trauma-informed care

maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries

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choice - trauma-informed care

prioritizing consumer choice and control

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collaboration - trauma-informed care

maximizing collaboration and sharing of power with consumers; integrating care

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empowerment - trauma-informed care

prioritizing consumer empowerment and skill-building; relationships heal, recovery is possible

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treatments of ODD and CD

punitive treatments appear to intensify rather than correct behavior

effective treatments tend to focus on the cohesive family model and behavioral techniques

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parent training

general strategies:

focus on rewards, not punishment

ignore negative behaviors

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token economies

general rules:

positive

specific

limited

achievable