Chapter 13 (health related disorders)

trends in substance abuse?

• Substance use levels have remained steady since 2021

• Most used: alcohol (22%) then vapes (15%) and then cannabis (12%)

  • Mainly in grade 12 studies, gender diverse, and rural.

Health-related difficulties and medical stressors are different than other disorders in that children’s ___________ are more directly connected to the impact of the physical illness.

adjustment difficulties

Adverse childhood experience (ACE) study

• Mid 1990s

• role of traumatic childhood events in negatively impacting adult health

  • At least ONE ace --> link to childhood trauma and adult chronic disease.

______ children are not getting enough sleep

1 in 4

Sleep is the_____________ during the early years of development

primary activity of the brain

A __________ relationship exists between sleep problems and psychological issues

bidirectional

Sleep disorders can:

• Cause other psychological problems

• Result from other disorders

• Mimic or worsen symptoms of major disorders

What are the 3 regulatory functions of sleep?

1. Sleep is essential for brain development

 

2. Sleep deprivation impairs executive functioning of the prefrontal cortex

 

3. Sleep produces an “uncoupling” or disconnection of neurobehavioral systems

sleep deprivation leads to

decreased concentration and diminished ability to inhibit or control basic drives, impulses, and emotions

What does an “uncoupling” of the brain mean in sleep?

• Allowing for retuning of CNS components, giving it a break from constant work.

• This disconnection is more important earlier in life.

What sleep problems does each developmental stage have?

• Infants and toddlers: more night-waking problems

• Preschoolers: more falling-asleep problems

• Younger school-age children: more going-to-bed problems

• Adolescents have increased need for sleep, but are often sleep deprived

Primary sleep disorders are the result of

abnormalities in the body’s ability to regulate sleep-wake mechanisms and the timing of sleep.

What are the two types of sleep-wake disorders?

Dyssomnias
Parasommnias

Dyssomnia

disorders of initiating or maintaining sleep

 

• Are characterized by difficulty getting enough sleep, not sleeping when one wants to, and not feeling refreshed from sleep

• Involve disruptions in the sleep process

• May resolve themselves as the child matures

• Are quite common in childhood, except for narcolepsy

Types of dyssomnias?

1. insomnia disorder?

2. hypersomnolence disorder

3. narcolepsy

4. breathing-related sleep disorder

5. circadian rhythm sleep disorder

Sleep Disorder	Description	Prevalence and Age	Treatment
Insomnia Disorder
Hypersomnolence Disorder
Narcolepsy
Breathing- Related Sleep Disorder
Circadian Rhythm Sleep Disorder

Sleep Disorder	Description	Prevalence and Age	Treatment
Insomnia Disorder	Difficulty initiating or maintaining sleep, or sleep that is not restorative; in infants, repetitive night waking and inability to fall asleep	25% to 50% of 1-to 3-year-olds	Behavioural treatment, family Guidance
Hypersomnolence Disorder	Excessive sleepiness that is displayed as either prolonged sleep episodes or daytime sleep episodes	Common among young children	Behavioural treatment, family guidance
Narcolepsy	Irresistible attacks of refreshing sleep occurring daily, accompanied by brief episodes of loss of muscle tone (cataplexy)	<1% of children and adolescents	Structure, support, psychostimulants, Antidepressants
Breathing- Related Sleep Disorder	Sleep disruption leading to excessive sleepiness or insomnia that is caused by sleep-related breathing difficulties	1% to 2% of children; preschool, elementary ages	Removal of tonsils and adenoids
Circadian Rhythm Sleep Disorder	Persistent or recurrent sleep disruption leading to excessive sleepiness or insomnia due to a mismatch between the sleep-wake schedule required by a person’s environment and his or her internal sleep cycle (circadian rhythm); late sleep onset (after midnight), difficulty awakening in morning, sleeping in on weekends, resistance to change	Unknown; possibly 7% of adolescents	Behavioral treatment, chronotheraphy

Treatment for dyssomnias include _________

behavioural interventions

Behavioural interventions for dyssomnias

Attend to the child’s need for comfort and reassurance, then gradually withdraw more quickly from the child’s room (leads to extinction)

 

• Establish age-appropriate good sleep hygiene

• Apply positive reinforcement methods (ex. praise, star charts)

• Identify suspected causes of disrupted sleep

 

Goal is to eliminate this sleep deprivation and restore a normal sleep wake routine.

Parasomnias

Disorders in which behavioural or physiological events intrude on ongoing sleep

 

• Involve physiological or cognitive arousal at inappropriate times during sleep-wake cycle

• Complaints of unusual behaviours while asleep

 

• Common afflictions of early to mid-childhood

• Children typically grow out of.

Parasomnias include nightmares (_________) and sleep terrors and sleepwalking (____________)

REM parasomnias
often referred to as arousal parasomnias or NREM

Types of parasomnias?

1. nightmare disorder

2. NREM sleep arousal disorders

3. sleep terrors

4. sleepwalking

Sleep Disorder	Description	Prevalence and Age	Treatment
Nightmare Disorder
NREM Sleep Arousal Disorders
Sleep Terrors
Sleepwalking

Sleep Disorder	Description	Prevalence and Age	Treatment
Nightmare Disorder	Repeated awakenings with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security, or self-esteem; generally occurs during the second half of the sleep period	Common between ages 3 and 8	Provide comfort, reduce stress
NREM Sleep Arousal Disorders
Sleep Terrors	Recurrent episodes of abrupt awakening from sleep, usually occurring during the first third of the major sleep episode and beginning with a panicky scream; accompanied by autonomic discharge, racing heart, sweating, vocalized distress, glassy-eyed staring; difficult to arouse, inconsolable, disoriented; no memory of episodes in morning	3% of children; ages 18 months to 6 years	Reduce stress and fatigue; add late afternoon nap
Sleepwalking	Repeated episodes of arising from bed during sleep and walking about, usually during the first third of the major sleep episode; poorly coordinated, difficult to arouse, disoriented; no memory of episode in morning	15% of children have one attack; 1% to 6% have one to four attacks per week; age 4 to 12 years, rare in adolescence	Take safety precautions, reduce stress and fatigue, add late afternoon nap

Treatments for parasomnias?

• Prolonged treatment of parasomnias is usually not necessary

 

• Treatment of nightmares

  • Provide comfort at the time of the occurrence and attempt to reduce daytime stressors

 

• Parents of sleepwalkers should take precautions to avoid chances of the child being injured

  • Brief afternoon naps may be beneficial

In addition to the descriptions provided in table 13.1 and 13.2; a DSM-5 diagnosis for a sleep disorder requires:

1. The presence of clinically significant distress or impairment in social, occupational, or other important areas of functioning

 

2. The sleep disorder cannot be better accounted for by another mental disorder, the direct physiological effects of a substance, or a general medical condition.

Enuresis

Involuntary discharge of urine occurring in persons over 5 years of age or the developmental equivalent.

 

Diagnostic criteria (+ specify if nocturnal, diurnal, or both):

 

(A) Repeated voiding of urine into bed or clothes, whether involuntary or intentional.

(B) The behavior is clinically significant as manifested by either a frequency of at least twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

(C) Chronological age is at least 5 years (or equivalent developmental level).

(D) The behavior is not attributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure disorder).

 

• May have deficiency in ADH hormon

Encopresis

The passage of feces in inappropriate places, such as in clothing, whether involuntary or intentional.

 

Diagnostic criteria:

 

(A) Repeated passage of feces in inappropriate places (e.g., in clothing, on floor), whether involuntary or intentional.

(B) At least one such event occurs each month for at least 3 months.

(C) Chronological age is at least 4 years (or equivalent developmental level).

(D) The behavior is not attributable to the physiological effects of a substance (e.g., laxatives) or another medical condition, except through a mechanism involving constipation.

Chronic illness

Persists for more than three months in a given year or requires a period of continuous hospitalization for more than one month

_______ of youths under age 18 will experience one or more chronic health conditions

10-20%

• Approximately 5% of these children suffer from a disease so severe that it interferes with daily activities.

• 2/3 have mild conditions

somatoform disorders / Somatic symptom and related disorders

"a group of related difficulties involving distressing somatic symptoms, such as pain and dizziness, that interfere with daily activities"

• emphasis is on the way a child or youth presents with and interprets their symptoms

 

_________ is the most common chronic illness in childhood, followed by neurological and developmental disabilities and behavioural disorders.

Asthma

Diabetes mellitus

a lifelong metabolic disorder in which the body is unable to metabolize carbohydrates because the pancreas releases inadequate amounts of insulin.

 

• The lack of insulin prohibits glucose from entering the cells, forcing glucose to accumulate in the blood (hyperglycemia)

Diabetes mellitus treatment

Treatment regimen includes insulin injections, diet, and exercise

 

• Metabolic control (of glucose levels) is intrusive and can be especially difficult during adolescence

Behavioural strategies:

• Help promote regimen adherence, metabolic control, and family adaptation

• Reinforce symptom reduction or medication use, and self-control methods

 

Diabetes mellitus prevalence

• No gender differences

• Rates of the disease are increasing

  • Today’s children have a one in three chance of being diagnosed with diabetes

prevalence of childhood cancer

• White children have highest rates of cancer.

 

• Approximately 80% of pediatric cancer patients survive

• 50% will have serious physical or mental illness as adults and will require long-term care

Most common type is _____________ (accounts for 50% of childhood cancers) that targets the bone marrow.

acute lymphoblastic leukemia

_______ of parents of children with chronic illness suffer from symptoms of PTSD.

10%

Children with more severe, disruptive illnesses suffer primarily in social _______.

adjustment

• Maladjustment may be expressed by displaying submissive behavior with peers and engaging in less social activity

• Social adjustment problems are linked to CNS illnesses (cerebral palsy, spina bifida, brain tumors) because they impact cognitive abilities such as social judgment

The transactional stress and coping model

Explains how adaptation to chronic illness is influenced by the nature of the illness, and also by personal and family resources.

 

• Child and family processes mediate the illness-outcome relationship

• Psychological mediators include parental adjustment, child adjustment, and their interrelationship

What are the 3 parts of the transactional stress and coping model?

1. Illness parameters --> visible illness? Severe? Worsening or improving or stable? Intrusive procedures? Affects function?

2. Personal characteristics --> sex? Age? Ethnicity? SES? Intellectual ability? Coping skills? Self-concept? Appraisal?

3. Family adaptative and functioning --> families stress? Family self-efficacy? Active, solution-focused coping? Family functioning? Perceived support?

How do interventions empower families?

• Reduces stress and dependency, allows to make informed decisions.

• Support groups and educational programs

• Treatment-related activities based on needs of the family

substance use disorders (SUDs)

Disorders that occur during adolescence and include substance dependence and substance abuse that result from the self-administration of any substance that alters mood, perception, or brain functioning.

Substance use disorders diagnostic criteria?

A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

• larger amounts or a longer period

• desire or unsuccessful effort to cut down

• time is spent in activities to obtain substance,

• craving

• results in failure to fulfill major role obligations

• Continued substance use despite problems in life from it.

• Important social, occupational, or recreational activities are given up

• recurrent substance use in situations in which it is physically hazardous

• continued despite knowledge of having a persistent problem

• Tolerance (increased amounts, decreased effects)

• Withdrawal

Substance use disorders involve at least _____ of the symptoms, occurring within a _______ period:

two

12-month

Difference with Substance-abusing adolescents

• More likely show cognitive and affective features of abuse or withdrawal.

• Experience withdrawal symptoms

• Their physiological dependence and symptoms are less common than the withdrawal symptoms experienced by adults

• Tend to drink less often, but drink larger amounts at any one time than adults drink

________ is the most prevalent substance used and abused by adolescents

Alcohol

Critical risk factor for substance use disorder is ______

age of first use

• Adolescent traits lend to vulnerability to drug use

  • Can cause neurobiological changes that further increase risk of substance use disorders

 

• Alcohol use before the age of 14 is a strong predictor of subsequent alcohol abuse or dependence

  • Especially when early drinking is followed by rapid escalation in the quantity of alcohol consumption

Sex differences in substance use disorders?

• Sex differences in lifetime prevalence rates are converging due to increased substance use among girls

 

• Rates of diagnoses for SUDs no longer differ significantly between boys and girls

 

• There is support for looking more carefully at socioeconomic status rather than just race/ethnicity

Alcohol use influences other high-risk behaviors:

• Unsafe sexual activity, smoking, and drinking and driving

• Girls who report dating aggression are five times more likely to use alcohol than girls in nonviolent relationships

• Drug overdose deaths among adolescents increased from 282 deaths in 2019 to 546 deaths in 202

• Rise in fentanyl-laced substances the likely culprit

With associated characteristics of Substance use disorder, Those who fit criteria for SUD often:

• Are using more than one drug simultaneously

• Poor academic achievement, higher rates of academic failure, and higher rates of delinquency

• More parental conflict

• Disruption of neurodevelopmental processes

• Poorer cognitive functioning

  • Learning and attention

  • Psychomotor speed

  • Executive functioning and impulsivity

3 main causes of SUD?

Personality and developmental factors:

• Increased sensation seeking preference for novel, complex, and ambiguous stimuli

• Circadian imbalance and its related effects on brain development may explain the increased risk taking and sensation-seeking during adolescence

• Having positive attitudes about substance abuse, having friends with similar values, attitudes about school.

 

Family Background:

• Family history for alcoholism (ex. greater activation in frontolimbic area)

• Parents giving alcohol access, attitudes toward alcohol, monitoring, relationship, support, and lack of parental involvement

 

Peers and culture:

• association with deviant and substance-using peers

• Everybody’s doing it, fitting in

_____ of adolescents getting treatment relapse within the first 3 months after

Only _____ remain abstinent at 1 year.

50%

20-30%

3 types of treatment for SUDs?

1. family based approaches

2. motivational interviewing

3. multisystemic therapy (MST)

motivational interviewing

• patient centred approach, addresses ambivalence and discrepancies between a person’s current values and behaviors and their future goal

 

• Adolescents with more severe levels of abuse require an inpatient or residential setting

Multisystemic therapy (MST)

Effective approaches address multiple influences (peer, family, school, and community) on the individual.