CLP4134- ABNORMAL CHILD PSYCH

Exam 3

What is the difference between MDD & PDD?

PDD is more chronic but less severe and has longer episodes than MDD

MDD symptoms

* depressed mood most of the day nearly every day (can be irritable mood for children/adolescents)
* diminished interest/pleasure in all activities most of the day.
* significant weight loss or gain; change in appetite
* insomnia/hypersomnia nearly every day
* psychomotor agitation
* fatigue/loss of energy nearly every day
* feelings of worthlessness
* diminished ability to think or concentrate
* recurrent thoughts of death, recurrent suicidal behaviors

PDD symptoms

* depressed mood most of the day nearly every day (can be irritable mood for children/adolescents)
* poor appetite/overeating
* insomnia/hypersomnia
* low energy/fatigue
* low self-esteem
* poor concentration
* feelings of hopelessness

MDD prevalence, onset, course:

* 11-20% lifetime childhood prevalence
* age onset: 13-15 years
* length of episode: 8 months

PDD prevalence, onset, course:

* 1% children
* 5% adolescents
* age onset: 11-12 years
* length of episode: 2-5 years
* chronic, less severe than MDD

Both MDD and PDD___

Cannot have manic or hypomanic history to meet criteria

Females are ____as likely as males to suffer from depression.

twice as likely

Sex difference is not present among ages _____

6 to 11

euthymic mood 

 a normal, tranquil mental state or mood

ex. the mood that is neither manic nor depressive in BP

common characteristics associated with depressive disorders include:

* interference with academic performance
* low self-esteem
* social problems
* co-rumination with peers

most common comorbid diagnosis for PDD

MDD

most common comorbid diagnosis for MDD

anxiety disorders

Prevalence/course of suicidal thoughts

appears more in adolescence than childhood

Suicidality is a symptom of what disorder?

MDD

risk factors for suicidal thoughts include:

* various types of psychopathology (ex. conduct problems)
* psychological stressors
* family problems
* bullying

T/F: Proposed causes of depressive disorders include vulnerability as a moderating factor

false

Proposed causes of depressive disorders:

* genetic and family risk
* inherited vulnerability with environmental stressors as a moderating factor
* Neurobiological influences (ex. low levels of serotonin, norepinephrine…)
* cognitive influences (ex. negative cognitive triad)

main treatment strategies for depressive disorders in children/adolescents include:

* sleep hygiene
* CBT (most common and effective)
* behavioral activation (increase of pleasurable activities)
* Interpersonal psychotherapy for adolescents (IPT-A)
* medication

T/F: Medication used for depressive disorders are often used and more effective in more severe cases

true

Infants sleep___

the most

Toddlers sleep____

a bit less

School age children sleep ____than toddlers

less

Adolescents at least sleep about

8-10 hours

_____ have the most physiological need for sleep and have more diverse sleep issues compared to _____.

Adolescents; children

Sleep issues can ______disorder severity.

cause/exacerbate

Disorder severity _____ lead to sleep problems.

can

Dyssomnias are:

any disorder characterized by disturbances of amount, quality or timing.

Types of Dyssomnias include:

* insomnia
* narcolepsy

Types of Parasomnias include:

* Nightmare disorder
* sleep terrors
* sleepwalking

Sleep terrors and sleepwalking are considered:

Non-REM Sleep Arousal Disorders

T/F: Insomnia is the most common sleep disorder in children and adolescents.

true

Diagnostic criteria for insomnia include trouble falling asleep, staying asleep, or __ for at least 1 month, cause significant ____ or ______

non-restorative sleep; distress; impairment

T/F: Narcolepsy is very prevalent among the other sleep-disorders.

False

REM (Rapid Eye Movement):

dreams and nightmares happen; common in later stages of sleep; remember most details of nightmares; hard to parse apart from PTSD

NREM (Non-Rapid Eye Movement):

sleepwalking, and sleep/night terrors (abrupt/fearful \n awakening) happen; common during earlier stages of sleep; usually not remembered much at all

SUD is

a pattern of substance use causing significant impairment or distress

DSM-5 classes for SUDs include:

* alcohol
* caffeine
* tobacco
* cannabis
* hallucinogens
* inhalants
* opioids
* sedatives
* stimulants

Four domains of SUDS:

* psychological dependence
* physical dependence
* withdrawal
* physical tolerance

Physchological dependence

subjective feeling of needing the substance to function

physical dependence

body adapts to constant presence of substance

Withdrawal

adverse physiological symptom experienced when substance is removed from the body

physical tolerane

body requires more of the substance to experience the same effect one obtained at a lower dose

central diagnostic feature

The substance is often taken in larger amounts or over \n a longer period than was intended

4 categories of clinical distress/impairment:

* impaired control
* social impairment
* risky use
* pharmacological criteria

With SUDs impairment and distress is defined as

presence of symptoms

Which substance is the most commonly used and abused?

alcohol

T/F: SUDS and substance use often co-occur with other mental health disorders, especially ADHD ad ODD

true

__ ______use more substances prior to late adolescence than _____.

Boys; girls

harmful use of substances peak in

late adolescence (17-22)

T/F: Cigarettes, alcohol and marijuana are gateway drugs

false

common characteristics of SUDs in adolescents:

academic difficulties, externalizing behavior, family \n problems, peer problems

Causes for SUDS include:

* genetic factors
* family environment
* peer pressure
* neurobiological

Treatments for SUDs include:

* Family-based interventions
* cognitive-behavioral therapy
* school and community-based prevention programs

T/F: SUDs treatments have high relapse rates.

true

developmental risk factors for eating disorders

* social expectation
* drive for thinness
* focus on dieting and weight

Set point:

the body’s ‘ideal’ weight maintenance mechanism

serotonin modulates

hunger

binge eating

involves periods of excessive eating, accompanied by a feeling of a loss of control. No compensatory behaviors

prevalence for binge eating

girls/women more likely than boys/men

AFRID (Avoidant/restrictive food intake disorder):

avoidance or restriction of food intake, leading to significant weight loss(or failure to maintain normal growth) and/or nutritional deficiency

Subtypes of AFRID:

* sensory sensitivity (“picky eating”)
* limited appetite
* fear of aversive consequences

T/F: Family members can increase severity of AFRID by accommodating restrictive eating

true

AFRID is often treated with

exposure therapy

AFRID comorbidities

* autism
* anxiety disorders
* gastrointestinal problems
* depression/suicidality

Pica is

the ingestion of inedible substances (ex. hair, insects, etc.)

AFRID: prevalence, onset

* 3.2% of 8-13 year olds
* onsets by childhood, worse if onset age by 2

Pica: prevalence

* overall prevalence somewhat unclear
* most common during infancy/early childhood
* last several months but usually remits

Pica is commonly co-occurring with

intellectual disabilities

T/F: Pica often remits on its own without treatment

true

Anorexia Nervosa (AN):

low weight, body shape/appearance critical for self-image, fear of gaining weight/eating

AN can include

binge eating; binge and purge subtype

Another subtype of AN includes:

restricting (dieting, fasting, excessive exercise)

AN: adolescent prevalence, course, onset

* 0.3%
* onset during adolescence (14-18)
* gradual course, starting with dieting
* lifelong impairment, high mortality

AN onsets earlier than BN and is ____ difficult to treat.

more

T/F: SSRI medications are effective for AN treatment.

false

Bulimia Nervosa (BN):

binge eating without perceiving control, purging/compensatory behaviors, body shape/appearance critical for self-image

BN is effectively treated with

CBT

BN: prevalence, course, onset

* 0.9%
* late adolescence/young adulthood

SSRIs can help ____ BN/BED severity, possibly due to lowering comorbid symptoms (e.g., depression), but also from modulating hunger

reduce

BN is believed to be _______ to western society.

“culturally-bound”

Binge-Eating Disorder (BED):

binge eating without perceived control, no purging/compensatory behaviors following binge eating, distress about binge eating

T/F: BED is believed to be “culturally-bound” to western society

true

traumatic events

* actual or threatened harm or fear of death/injury
* uncommon or extreme stressors

stressful events

more common, less extreme

child maltreatment

* abuse: physical, sexual, emotional/psychological
* neglect: physical, educational, emotional (represents 75% of maltreatment cases)

Abuse prevalence

* 1 in 4 girls vs. 1 in 20 boys experience sexual abuse/assault
* 1 in 10 children physically abused by caregiver

abuse outcomes

* immediate: profound changes in mood, arousal, behavior
* long term: 33% develop PTSD/other mental disorder

Reactive Attachment Disorder (RAD):

a pattern of disturbed and developmentally inappropriate attachment behaviors.

Disinhibited Social Engagement Disorder (DSED):

a pattern of overly familiar and culturally appropriate behavior with relative strangers

Similarities of RAD and DSED:

* inappropriate behaviors with unfamiliar adults
* patterns with insufficient care
* developmental age of 9 months

differences between RAD and DSED:

* patterns of behavior
* prognosis
* DSED linked to ADHD and disruptive behaviors; RAD linked to internalizing disorders

DSED is

usually more persistent, even with stable housing

Posttraumatic Stress Disorder Disorder (PTSD):

a display of persistent anxiety following an overwhelming traumatic event that occurs outside the range of usual human experience.

PTSD symptoms

* negative altercations in cognition and mood
* intrusion symptoms
* avoidance symptoms
* alterations in arousal and reactivity

Children 6 years or younger suffering from PTSD may

* have difficulty articulating thought/feelings
* use play reenactment to display feelings/memories
* experience nightmares instead of flashbacks

PTSD prevalence, course, onset

* onsets within 3 months of trauma
* 2/3 of youths have experienced at least one potentially traumatic event before adulthood
* girls: 6.3 vs. boys: 3.7%

PTSD comorbidities

* anxiety & depressive disorders
* suicidality
* substance use problems

Treatment for RAD

attachment & biobehavoral catch-up (ABC)

ABC:

* improve quality of attachment between caregivers and young children
* caregivers learn how to read children’s needs and signals
* caregivers learn how to respond and provide care in a sensitive, nonintrusive manner

DSED treatment

* prevention by providing stable, consistent care prior to 6 months of age
* difficult to correct in toddlers and older children