PBSI 407 Exam 3

Oppositional Defiant Disorder (ODD)

negativistic, hostile, defiant, loses temper, argues with adults, deliberately annoys others, blames others, stubborn

lasts for at least 6 months and impairs functioning

boundary setting/restrictions

in the infancy to toddler transition, this increases which can be upsetting

explains why we see tantrum behavior in toddlers

infancy to toddler transition

ODD is typically thought of as this developmental transition going awry

this transition allows increased expansiveness and exploration, autonomy, and more restrictions

when this warrants ODD look at FIDs, difficulty calming down, aggression, self-harm, and public tantrums

stable

ODD is ______, is more of an entry point to other conduct disorders

CD, ADHD, anxiety, depression

common comorbidities in ODD

animals

aggression towards _______ can indicate ODD

Conduct Disorder (CD)

a repetitive and persistent pattern of behavior in which either the basic rights of others or major age-appropriate societal norms or rules are violated

overt aggression

arguing, fighting

covert aggression

lying, stealing

CD symptoms clusters

aggression to people or animals

destruction of property

deceitfulness or theft

serious violation of rules

early onset

when ODD is __________ we see more aggression and rule-breaking and it is typically more severe and persistent

parent driven

the development of ODD is very ___________

alpha commands

parent commands that are _______________ are clear, direct, brief, and given in the form of a statement

beta commands

parent commands that are ___________ are nonspecific, long, and stated as a question

these commands lead to ODD behavior

negative attention

giving attention to negative behavior, paying more attention to the negative things rather than the positive

childhood onset (life-course persistent)

type of CD in which the symptoms are present before the age of 10

typically see overt aggression like physical violence

inattention, impulsivity, and poor academics also common

more often in males

adolescent onset

type of CD in which symptoms onset after the age of 10

kids are normal in the early development and have less severe problems and less physical violence

boys and girl equally likely to develop, fewer comorbidities and family dysfunctions

ODD

most cases of CD are preceded by this

proactive aggression

instrumental, cold blooded, used for personal gain or to influence others

high IQ, more verbally affective

reactive aggression

defensive reaction to perceived threat, associated with anger, hostility, and impulsivity

seen in kids with low emotional intelligence

typically associated with hostile attribution bias

patterson’s coercion theory

the way that parents discipline and monitor their children can lead to ODD

controlling each other through coercion (threatening), child lacks management strategies, parents train their children to respond antisocially

negative reinforcement

negative reinforcement

how conduct disorders are created by transactional parenting patterns

child receives a positive outcome with negative behaviors so they keep doing it

social learning theory

learning aggressive behavior through observation of aggressive behavior, explaination for development of conduct disorders

i.e. being in a violent neighborhood and learning behavior by watching

callousness

lack of remorse or guilt, a psychopathic trait

small subset of CD kids have these traits

ADHD

ODD and CD are both highly comorbid with this

aggression

big indicator of future problems

relational aggression

girls are more likely to display this form of aggression, includes exclusion, rumor spreading, and relational threats

gender nonnormative

this type of aggression typically indicates more severity

i.e girls physically fighting

Bipolar I

need at least one manic episode

depression often occurs but is not necessary for diagnosis

Bipolar II

at least one hypomanic episode and at least one major depressive episode

no full mania

cyclothymic disorder

chronic mood fluctuations, symptoms do not meet full criteria for mania or depression

less severe, more chronic

major depressive episode

depressed or irritable mood and/or loss of interest for at least 2 weeks

required in order to diagnose MDD

2 weeks

how long do symptoms need to persist in order to be diagnosed with MDD?

SIGECAPS

useful assessment heuristic for depressive symptoms

sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide

what does SIGECAPS stand for?

Persistent Depressive Disorder (PDD)

more chronic depressive symptoms, less severe presentation that MDD in many cases

duration of at least a year

associated with longstanding low mood, low self-esteem, reduced enjoyment, and chronic interpersonal and/or academic strain

Major Depressive Disorder (MDD)

requires 5+ symptoms (including a major depressive episode) during the same 2 week period

symptoms must represent a change from prior functioning and cause clinical impairment or significant distress

Manic episode

abnormally elevated, expansive or irritable mood for at least one week

marked impairment or risk

Hypomanic episode

similar to mania but less severe, at least 4 days

no marked impairment

major depressive episode

depressed or irritable mood and/or loss of interest for at least 2 weeks

irritability

key feature seen in young kids with depression

Double Depression

can occur when major depression is superimposed on chronic low mood (MDD + PDD)

Becks Cognitive Theory

biased thinking patterns in depression, negative views are organized around the cognitive triad (self, world, future)

rumination

after puberty, girls have diagnosed depression than boys because of this

internal, stable, and global

with kids with depression, negative events are often interpreted as this

this pattern promotes hopelessness

self, world, future

according to Becks Cognitive Triad theory of depression, depressed individuals have thinking errors that relate to these three things

aggression towards people/animals, property destruction, deceitfulness/theft, rule violation

CD symptoms fall into these 4 categories

are rarely mutually exclusive

adjustment disorder with depressed mood

depressive symptoms emerge in response to an identifiable stressor (divorce, relocation, family disruption, school transition, etc)

context-linked, less severe than MDD

typically time limited but can develop into MDD

learned helplessness

how much control (or lack thereof) we think we have in a situation

perceived lack of control is common in depression

low perceived control → low effort given → lack of reinforcement possibilities

the developmental cascade for learned helplessness in depression

proactive coping

very protective against learned helplessness in depression

actively doing something about your issues

interpersonal theory

depression is often embedded in relational difficulties

familial or peer relations, low perceived competence

can be both a cause or consequence of depression

overgeneralization, personalization, catastrophizing, selective attention to negative information

common cognitive disorders associated with depression

ADHD and bipolar

overlap are seen between these two disorders

impulsive, distractibility, activity level, talkativeness

chronic; episodic

ADHD and Bipolar disorders share some commonalities, the way to differentiate it is ADHD is ________ and Bipolar is _________

shorter, daily fluctuations

manic behavior in kids is this compared to adults

risk-taking or decreased need for sleep

to differentiate between mania and normal behaviors one of these two things need to be present

extreme, sustained, dysregulated, impairing

clinical concern for mania v normal mood arises when a child’s mood is _______________________________

parental depression

huge risk factor, not entirely specific (can lead to psychopathology more broadly)

anxiety

natural, adaptive alarm system, designed to detect and respond to potential threats

is often cognitively elaborated

anxiety disorders

which kind of disorder is most common in children and adolescents

fear

response to an immediate, present danger and tends to be stimulus bound

acute and action-oriented

multicomponent response system

looks at anxiety as having three components, cognitive, behavioral, and physiological

these all interaction, and change in one component alters the others

cognitive

one component in the multicomponent response system, includes threat expectancy, prediction, and worry

anxious kids: What if thinking, catastrophic predictions, underestimating ability to cope

behavioral

one component in the multicomponent response system, includes avoidance, escape and reassurance

safety behaviors

an action that anxious children take to reduce discomfort without resolving fear

reduces short term but makes anxiety worse in the long time

uncertainty

anxious kids are often intolerant of this

physiological

one component in the multicomponent response system, includes arousal and somatic distress

hypervigilance

common physiological response in anxious children

avoidance

maintainer/mechanism of anxiety

with this there is no opportunity for a corrective experience

dimensional model

diagnostic model that looks at how severe, broad, and impairing the child’s anxiety is

this model is better than categorical because most people with an anxiety disorder struggle with other forms of anxiety

behavioral inhibition

early temperament style marked by caution, withdrawal, and sensitivity to novelty

strong predictor of anxiety, especially SAD

expectancy violation

need this in order to recover from anxiety

information transmission

how a child can develop anxiety, if threatening messages are being transmitted from caregiver they can learn that they are supposed to be afraid of things

information processing biases

cognitive process that is a risk factor for the future development of anxiety

preferentially attend to threatening cues in their environment, often interpret ambiguity as dangerous, rejecting, embarrassing, or otherwise harmful

anxiety sensitivity

fear of anxiety-related sensations and their perceived consequences

arousal means danger, social exposure, or loss of mental control and this often feeds on itself and creates more anxiety

is a very strong predictor of an anxiety disorder

integrative model

model that explains the development of anxiety

1. temperament and biology shape initial anxiety sensitivity

2. leaning, parenting, and context influence how the threat is represented and managed

3. avoidance maintains the symptoms

perceived control

kids with anxiety often think this about themselves in their situations

separation anxiety disorder

child shows excessive distress or worry regarding separation from attachment figures

fears involve harm, illness, loss, or inability to cope without the caregiver nearby\

see behaviors like school refusal, not sleeping alone, and clinginess

social anxiety disorder (SAD

core fear is not social contact itself but being judged, rejected, embarrassed or exposed

anxiety begins before event through anticipatory worry and rehearsal of possible mistakes

common behaviors include blushing, trembling, nausea, or freezing

post-event rumination

see this is SAD, involves replayed events after the encounter

typically perceive that their interactions went poorly, but with unbiased raters they tend to look like normal kids

generalized anxiety disorder (GAD)

the child experiences excessive, difficult to control worry across multiple everyday areas of life

doesn’t feel like they can control or stop their worries

often are fatigues, irritable, tense, and have poor concentration

sleep problems

what is a good predictor of GAD?

panic disorder (PD)

requires recurrent unexpected attacks plus ongoing concern about future attacks or their meaning (uncued and do not know why they occured)

introspective threat

central aspect of PD, the body itself becomes part of what is feared

agoraphobia

the fear of being unable to escape

often occurs alongside PD

specific phobias

fear is focused on a specific object or situation

animals, environmental, blood-injection-injury, or situational

response to trigger is excessive relative to actual danger

obsessive-compulsive disorder (OCD)

need either an obsession or a compulsion in order to be diagnosed

obsession

intrusive thoughts, images, or urges that feel distressing, sticky, or difficult to dismiss

compulsion

repetitive acts or mental rituals performed to reduce distress or prevent feared outcomes

relief is temporary which reinforces the cycle

posttraumatic stress disorder (PTSD)

follows exposure to actual or threatened death, serious injury, or sexual violence

four domains of symptoms: re-experiencing, avoidance, negative cognitive or mood changes, and hyperarousal

may show trauma-linked play, nightmares, irritability, or cue-triggered distress

reflects persistent threat activation

re-experiencing, avoidance, negative cognition, and hyperarousal

the 4 domains of symptoms in PTSD

selective mutism

child speaks normally in some settings but consistently fails to speak where speech is socially expected

most often linked to severe social anxiety rather than oppositional refusal, might act as a mechanism to sooth social anxiety

impairment common at school

school refusal

pattern of non-attendance or extreme difficulty attended because attendance is emotionally distressing

can be driven by any anxiety disorder

parent accommodation and negative reinforcement often help maintain the pattern

Depression

a common comorbidity with anxiety, these have shared mechanisms like negative affect, avoidance, and threat bias

threat, deprivation, or betrayal/violation

core dimensions of a traumatic experience (many kids experience more than one)

commission

acts of harm such as physical, sexual, or psychological abuse or exposure to violence

omission

failure to provide safety, supervision, care, or stimulation

physical abuse

involves acts that inflict or risk bodily harm by a caregiver or responsible adult

often organizes development around threat coercion and anticipation of punishment

may present with hypervigilance, aggression, irritability, or fearful compliance

neglect

acts of omission, inadequate nutrition, supervision, medical care, educational support, or emotional responsiveness

deprivation rather than fear developmentally wise

see language delay, poor regulation, social withdrawal, and diffuse developmental lag