hdfs exam 3

Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. _______ is the emotional response to real or perceived imminent threat, whereas _______ is anticipation of future threat.

fear ; anxiety

Anxiety disorders tend to be _____ with each other, but they can be differentiated by close examination of the types of situations that are feared or avoided and the content of the associated thoughts or beliefs.

highly comorbid

According to the DSM-5, many of the anxiety disorders develop in _____ if not treated.

childhood and will persist

Marie is 10 years old and is exhibiting signs of an anxiety disorder. When Marie leaves her parents' house, she is consistently unable to speak in social situations (e.g., at school) and it is now impacting her school performance and ability to communicate with peers. Marie is most likely exhibiting characteristics of which anxiety disorder?

selective mutism

Children diagnosed with separation anxiety disorder may be at _____ risks for suicide

increased

With respect to differential diagnosis efforts, clinicians have distinguished separation anxiety disorder from several other disorders to include which of the following:

• conduct disorder

• depressive and bipolar disorders

• psychotic disorders

• panic disorder

Individuals with ________ are fearful or anxious about or avoidant of specific objects or situations. This anxiety disorder may include marked fear or anxiety about flying, heights, animals, seeing blood, etc.

specific phobia

Females are affected more than males in which of the following disorders:

generalized anxiety disorder

In panic disorder, the individual experiences recurrent unexpected panic attacks and is persistently concerned or worried about having more panic attacks or changes his or her behavior in maladaptive ways because of the panic attacks (e.g., avoidance of exercise or of unfamiliar locations). Which symptom below is NOT a part of the DSM-5 diagnostic criteria for a panic attack?

headache

An essential feature of _________ is marked, or intense, fear or anxiety triggered by the real or anticipated exposure to a wide range of situations. These situations include using public transportation, being in open spaces, being in enclosed places, standing in line or being in a crowd, or being outside of the home alone in other situations.

agoraphobia

According to the DSM-5, the following disorders are classified within the Depressive Disorder category:

• disruptive mood dysregulation disorder

• dysthymia

• major depressive disorder

According to the diagnostic criteria for ________, the core diagnostic feature is chronic, severe persistent irritability.

Disruptive Mood Dysregulation Disorder

_____________ has a similar clinical presentation to Disruptive Mood Dysregulation Disorder. The central feature differentiating the two disorders involves the longitudinal course of the core symptoms (e.g., episodic vs persistent).

pediatric bipolar disorder

Which of the following are associated features of Major Depressive Disorder:

• tearfulness

• irritability

• brooding

• obsessive rumination

In ______ severe irritability (e.g., chronic, persistently irritable, or angry mood) is present between severe temper outbursts. 

DMDD

The essential feature of a major depressive episode is a period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activities (Criterion A). In children and adolescents, the mood may be _________ rather than sad.

irritable

Which of the following is a risk factor for Major Depressive Disorder (MDD)?

• neuroticism

• adverse childhood experiences

• having a first-degree family member with MDD

Dysthymia is also known as ____________________________. The essential feature of this disorder is a depressed mood that occurs for most of the day, for more days than not, for at least 2 years, or at least 1 year for children and adolescents (Criterion A). 

persistent depressive disorder

When a substance (e.g., cocaine, prescribed medication, toxin) is judged to be etiologically related to a mood disturbance can a diagnosis of Persistent Depressive Disorder still be given?   

no

Individuals diagnosed with either Conduct Disorder or Oppositional Defiant Disorder typically experience the first onset of concerning behaviors when they are ________________.

children/adolescents

The symptoms of Oppositional Defiant Disorder may be confined to only one setting, and this is most frequently the home. Individuals who show enough symptoms to meet the diagnostic threshold, even if it is only at home, may be significantly impaired in their ______________________. 

social functioning

EXAM LIKE QUESTION: Diagnostic criteria for Oppositional Defiant Disorder include a pattern of which three overarching behaviors?

Angry/Irritable Mood; Argumentative/Defiant Behavior; Vindictiveness

The neurodevelopmental disorder of __________ is often a comorbid diagnosis with Oppositional Defiant Disorder (ODD). To make the additional diagnosis of ODD, it is important to determine the context in which an individual fails to conform to requests of others.

ADHD

An individual diagnosed with Conduct Disorder who has been arrested for forced sex, physical cruelty, and use of a weapon while confronting a victim, would be assigned which severity level:

severe

____________ is defined as recurrent behavioral outbursts representing a failure to control aggressive impulses. It can be manifested by either 1) Verbal aggression or physical aggression toward property, animals, or other individuals, occurring twice weekly, on average, for a period of 3 months OR 2) Three behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period.

intermittent explosive disorder

Many of the symptoms that define disruptive, impulse-control, and conduct disorders are behaviors that occur, to some degree, in typically developing individuals. Therefore, it is critical that the _______ across situations is considered.

frequency, persistence and pervasiveness

what are mood disorders?

a group of psychological disorders characterized by the lowering or elevation of a person’s mood, such as depression or bipolar disorder.

what does a mood disorder look like in infants/toddlers?

emotional lability, difficult temperament styles

what does a mood disorder look like in prechool?

emotional lability, lack of interest in activities most children enjoy, muted affect expression, eeyore presentation

what does a mood disorder look like in school age?

sad, prefer to be alone, withdrawn, quiet, eating or sleeping disturbance

what does a mood disorder look like in adolescents?

adult like presentation, sad, withdrawn, poor sleep, lonely

What is the CES-D?

• most commonly used depression screener in research 

• score range 0-60

• scores of 16 or higher, generally generate a referral or injury 

disruptive mood dysregulation disorder signs and symptoms

• intense temper outbursts (consistent) towards people and property

• outbursts are inconsistent with developmental level

• 3+ times per week (outbursts)

• persistent irritable or mad mood most of the day and nearly everyday

• 12 or more months (criteria A-D)

• outbursts need to occur in 2/3 settings (school, home with peers)

• age of onset criteria A-E before 10 yrs

• diagnosis should not be made for 1st time before age 6 or after 18yr

• cannot coexist with ODD, intermittent explosive disorder or bipolar disorder.

Oppositional defiant disorder

• behavioral disorder 

• modd is typical outside of episodes

• not required to exist in a specific setting but must occur with at least one individual

• no minimum or max age of onset

major depressive disorder (DSM criteria) signs and symptoms

• five or more of the following symptoms in same 2 week period

  • diminished interest or pleasure

  • significant weight loss or gain

  • insomnia or hypersomnia

  • psychomotor agitation or retardation

  • fatigue or loss of energy

  • feelings of worthlessness or excessive/inappropriate guilt

  • diminished ability to think or concentrate

  • recurrent thoughts of death

• symptoms cause clinically sig. distress or impairment

• not bc of a substance or medical condition

• not better explained by schizophrenia

• never been a manic or hypomanic episode 

persistent depressive disorder (dysthymia) DSM5 signs and symptoms (criteria):

• depressed mood for most of day for at least 2 years

• with 2 or more of following

  • poor appetite

  • insomnia/hypersomnia

  • low energy

  • poor concentration

  • feelings of hopefulness

• individual has never been w/o symptoms in crit A/B for 2 months @ a time

• no manic or hypomanic eps

• not better explained by substances or clinical disorders

anxiety disorders

a group of psychological disorders characterized by significant feelings of anxiety and fear. anxiety is worry about future events and fear is a reaction to current events.

what does anxiety development look like in infants/toddlers?

excessive stranger anxiety

what does anxiety development look like in preschool?

transitions, social shyness, emotion dysregulation, phobias

what does anxiety development look like in school age?

excessive worry or fear, difficulty making friends, concentrating on school work,emotional lability or blunted response

what does anxiety development look like in adolescence?

excessive worry or fear, inability to control thoughts, school drop-out, often co-occurs with disordered sleep and maladaptive internalizing behaviors

DSM-5 anxiety disorders:

• separation anxiety disorder

• selective mutism

• specific phobia

• social anxiety disorder

• panic disorder

• agoraphobia

• generalized anxiety disorder

what is the GAD-7

• commonly used anxiety screener

• scores range from 0-21

separation anxiety disorder (DSM5 criteria)

• excessive fear or anxiety concerning separation evidenced by at least 3 of following:

  • experiencing separation

  • losing major attachment figures

  • experiencing an untoward event

  • refusal to go out

  • reluctance about being alone

  • refusal to sleep

  • repeated nightmares

  • repeated complaints of psychical symptoms

• lasting at least 4 wks in kids/teens, 6 months for adults

• clinically significant

• not better explained by other mental disorder

selective mutism (DSM5 criteria)

• consistent failure to speak in specific social situations

• disturbance interferes with educational or occupational achievement

• at least 1 month

• not better explained by communication disorder

Specific phobia (dsm5 criteria)

• marked fear or anxiety about a specific object or situation

• provokes immediate fear or anxiety

• objet or situation is actively avoided

• fear or anxiety is out of proportion

• persistent typically for 6 months or more

• clinically significant

• not better explained by symptoms of another mental disorder

social anxiety disorder (DSM-5 criteria)

• marked fear or anxiety about one or more social situations

  • children: anxiety must occur in peer settings not just w/ adults

• individual fears evaluation

• social situations almost always provoke fear or anciety 

• social situations are avoided

• out of proportion

• persistent 6 months or more

• clinically significant

• not bc of a substance

• not bc of another mental disorder

panic disorder (DSM-5 criteria)

• recurrent unexpected panic attacks during which time four (or more) symptoms occur

  • palpitations, sweating, trembling, shortness or breath, choking, chest pain, nausea, chills

• at least one of the attacks followed by 1 month or more of:

  • persistent concern or worry abt additional panic attacks

  • maladaptive change in behavior

  • not attributable to substance or mental disorder

agoraphobia (DSM5)

• fear or anxiety about two (or more) situations:

  • using public transport

  • being in open spaces

  • being in enclosed spaces

  • standing in line or being in crowd

  • being outside the home alone

• avoid these situations

• agoraphobic situations almost always provoke fear or anxiety

• out of proportion

• 6 months or more

• clinically significant and not bc of other mental disorder

generalized anxiety disorder (DSM-5) criteria :

• excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities

• difficult to control the worry

• clinically significant

• not bc of substance or meds use 

• not better explained by another mental disorder

The core diagnostic feature of________ for children is chronic, severe persistent irritability for 12 months or more.

Disruptive Mood Dysregulation Disorder

"Stranger anxiety" is a normative part of development and is typically observed at which of the following developmental ages

infancy

antisocial behaviors

disruptive acts characterized by covert and overt hostility and intentional aggression toward self or others 

unsocial behaviors

a term used to describe behaviors that are a normative part of adolescent development that align with the definition of antisocial behaviors (e.g., exploration of smoking or drinking)

what are some examples of antisocial behaviors?

• theft or destruction of property 

• assault

• murder or mutilation

• rape

what are some examples of unsocial behaviors?

• experimentation with drinking alcohol or smoking

• sexual activity in high school 

• peer exclusion and bullying 

• breaking curfew

what are some concerning behaviors in young kids (3-7 yrs) in regards to unsocial/antisocial development?

usually present with general defiance of adults wishes, disobedience of instructions, angry outbursts with temper tantrums, physical aggression to other people, destruction of property, arguing, blaming others and a tendency to annoy and provoke others.

what are some concerning behaviors in middle childhood ( 8-11 yrs.) in regards to unsocial/antisocial development?

features from early childhood are often present, but as child grows older other behaviors are seen, ex: stealing, swearing, lying about what they have been doing, persistent breaking of rules, physical fights, bullying other children, being cruel to animals and setting fires.

what are some concerning behaviors in adolescence (12 to 17) in regards to unsocial/antisocial development?

more antisocial behaviors are often added: hurting other people, assault, robbery using force, vandalism, breaking and entering houses, stealing from cars, driving and taking cars, running away from home, truancy, and misusing alcohol and drugs.

DSM-5: Disruptive, Impulse-Control, and Conduct Disorders

• Oppositional Defiant Disorder

• Intermittent Explosive Disorder

• Conduct Disorder

• Pyromania

• Kleptomania

Oppositional Defiant Disorder (DSM-5)

• pattern of angry/irritable mood for at least 6 months as evidenced by 4 symptoms from any of the 3 categories

  • angry/irritable mood

  • argumentative/defiant behavior

  • vindictiveness

intermittent explosive disorder (DSM-5)

• recurrent behavioral outbursts manifested by either of the following

  • verbal aggression

  • behavioral outbursts

• grossly out of proportion

• not premeditated

• cause marked distress

• at least 6 years old

• not better explained by another mental disorder

conduct disorder (DSM-5)

A repetitive and persistent pattern of violating the basic rights of others or societal norms/rules.

• Requires: ≥3 of 15 behaviors in past 12 months (with ≥1 in past 6 months)

  • Aggression to people/animals: bullies, fights, uses weapons, cruel to people/animals, stealing w/ confrontation, forced sex

  • Destruction of property: fire setting, deliberate destruction

  • Deceit/theft: breaking in, lying or “conning,” stealing nontrivial items

  • Serious rule violations: stays out at night (<13 yrs), runs away, truancy (<13 yrs)

• Causes significant social, academic, or occupational impairment

• If ≥18 yrs, criteria not met for Antisocial Personality Disorder

• mild, moderate or severe

pyromania DSM-5

• deliberate and purposeful fire setting on more than one occasion

• tension or affective arousal before the act 

• fascination with, interest in, curiosity about, or attraction to fire and its situational contexts

• pleasure, gratification or relief when setting fires or when witnessing or participating in their aftermath

• fire setting not done for monetary gain, or sociopolitical ideology, conceal crime

• not better explained by conduct disorder, manic episode

kleptomania (DSM-5) 

• recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value

• increasing sense of tension immediately before committing the theft

• pleasure, gratification, or relief at the time of committing the theft

• the stealing is not committed to express anger or vengeance and is not in response to a delusion or a hallucination

• not better explained by conduct disorder, manic episode or antisocial personality disorder

A diagnosis of _____ is a potentially appropriate diagnosis for an 8-year-old child experiencing aggressive outbursts

Intermittent Explosive Disorder

Which of the following is NOT a DSM-5 Disruptive, Impulse-Control, and Conduct Disorder?

bipolar diorder

Despite a number of common psychological and behavioral features between the DSM-5 Feeding and Eating Disorders, these disorders substantially differ in _________ needs.

clinical course, outcome, and treatment

For some individuals diagnosed with Avoidant/Restrictive Food Intake Disorder, food avoidance or restriction may be based on extreme sensitivities to the qualities of food, including _________.

• appearance

• color

• smell

• texture

• temperature

• taste

Darrius, a 16 year old cisgender male, is currently being evaluated for an eating disorder. As part of the intake process, the clinician measures his body mass index (BMI) to determine if it is below or within the expected the level for his age and height. Darrius' BMI was 25.2.

Which of the following eating disorder diagnoses is Darrius LEAST likely to receive:

anorexia nervosa

An essential feature of _______ is the eating of one or more nonnutritive, nonfood substances on a persistent basis over a period of at least 1 month that is severe enough to warrant clinical attention.

pica

According to Schaumberg et al. (2017), weight loss is a defining characteristic of (1) _______, but not (2) ___________ or (3) ____________. On average, which of the following three eating disorders BEST represent this statement?

anorexia, bulimia, binge

As mentioned in Schaumberg et al. (2017), eating disorders are ______but serious biologically influenced illnesses.

NOT choices

as discussed in Schaumberg et al. (2017), structural neuroimaging studies of individuals diagnosed with Anorexia Nervosa (AN) have predominately demonstrated reductions in ________, in various brain regions- highlighting brain structure and function differences do exist between individuals with AN and unaffected individuals.

grey matter

According to Schaumberg et al. (2017), genes alone ____ predict who will develop eating disorders.

do NOT

Lukens & Silverman (2014) estimate that up to  _____ % of neuro developmental challenged children have feeding difficulties.

80

____ of swallowing involves the pharyngeal transfer phase and begins when the bolus passes the faucial arches (near the tonsils) and triggers the start of the swallowing cascade.

phase 3

What is the earliest oral pattern and has been reported in fetuses by 15 weeks' gestation?

suckling

______ refers to food or a foreign substance entering into the airway.

aspiration

A feeding problem is considered a feeding disorder if the problem exists more than ___ months and/or results in 1) significant weight loss or nutritional deficiency, 2) dependence on tube feeding or nutritional supplements, or 3) impairment in psychosocial functioning in developmental deviation or delay.

one

Which of the following is NOT a cause for oral-motor problems in children?

neurodevelopmental disorders

_____ selectivity is most commonly seen in children with cerebral palsy who have oral-motor problems.

Texture-focused

Who on the interdisciplinary team can help to evaluate tongue movement with and without food in the mouth? This occupation can also facilitate more successful oral motor patterns by manipulating the texture or placement of food in the oral cavity.

speech language therapist

Problems with GI irritation and dysmotility can adversely affect _______, as well as the child's level of comfort, and should be treated.

respiratory and GI function

what are the four phases of swallowing?

• oral preparatory phase 

• oral transport phase

• pharyngeal transfer phase

• esophageal transport phase

When does sucking happen?

reflexive 3-4 months

when does sucking happen?

5 months, leads to spon feeding

when is the munching and chewing present?

9 months - 2 years old

a feeding problem is considered a feeding disorder if ….

• problem for more than 1 month

• significant weight loss or nutritional deficiency

• dependence on feeding tube or nutritional supplements

• impaired psychosocial functioning and developmental delay

what is aspiration?

food into the airway

what is food pocketing?

• holding food in the cheeks or front of mouth 

• may reflect difficulty with tongue movement 

• food sensitivity or refusal immature central transport pattern

• persistent suckle pattern

what is dysphagia?

difficulty or discomfort swallowing

feeding problems can include:

• difficulty chewing/swallowing (dysphagia)

• food selectivity 

• inadequate intake 

• total food refusal

what are some of the causes of feeding problems?

• anatomical abnormality

• motor/sensory dysfunction

• medical/psychological conditions

• growth abnormality

• learning difficulties

• social interaction difficulties

what are some feeding issues in children with neuro-developmental challenges?

• increased oral loss (messy eating)

• prolonged feeding time 

• food pocketing

• coughing, gagging, choking 

• aspiration

• food refusal

• food selectivity

• vomiting

• poor weight gain

what is dysmotility?

the phenomenon of “dumping” occurs when the stomach empties too rapidly. symptoms include nausea, vomiting, diarrhea, heart palpitations, and weakness

DSM 5 Eating and feeding disorders

• pica

• rumination disorder

• avoidant/restrictive food intake disorder

• anorexia nervosa

• bulimia nervosa

• binge-eating disorder

• other specified feeding or eating disorder

DSM-5 Pica

in take of nonnutritive or nonfood substances over the period of 1 month (commonly includes paper, soap, cloth, hair, string etc.)

what is the developmental course of pica?

• common in young kids but not clinically consequential

• occurs in otherwise typically developing children

• more common in child w/ developmental concerns

• in adults often associated with other forms of pathology

DSM-5 Rumination disorder

repeated regurgitation of food over a period of at least 1 month. not associated with known gastrointestinal or medical conditions or concerns about weight , food or body image.