Final Study Guide

Disorders:

• What is a disorder?
  • significant disturbance usually associated w/ significant distress and disability in social,occupational, or other important activities
  • an expectable or culturally approved response to a common stressor or loss such as the death of a loved one, is not a mental disorder
  • socially deviant behavior and conflicts that primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above
• Behavioral indicators of disorders
  • time course
    • developmental regression
    • development delay
    • difficulty persists over time
  • quantitative
    • high frequency /low frequency
    • high/low intensity
  • qualitative
    • inappropriate to a situation
    • behavior is different from normal
• Gender differences in diagnosis?
  • differential expressions
  • boys more biologically vulnerable
  • gender role socialization (emotional expression)
  • referral bias
    • male are more likely to be referred for diagnosis and treatment
    • one gender is more represented because they are studied more

1. Separation anxiety- excessive fear or anxiety when separated from an attached individual
   1. 3 of the following symptoms need to be present over a series of months
      1. excessive distress when anticipating or separated from home or attachment figure
      2. worry about losing attachment figure (illness, injury, disaster)
      3. worry and distress regarding events to themselves that may cause them to be separated from attachment figure
      4. refusal to go to school, sleep w/o figure, being alone or away from home or figure
      5. repeated nightmares about separation
      6. complaints about headaches, nausea, stomach aches when separation occurs
   2. more prevalent in children 12 or younger than in adolescents and adults
2. Social anxiety
   1. symptoms must be persistent for 6 months or more
      1. fear or anxiety about one or more social situations in which they may be exposed to scrutiny or judgemental from others
      2. for children, this occurs in peer settings and interactions with adults
      3. fearful that their symptoms will be on display for others to see and they’ll be judged humiliated, or rejected
      4. in children, this can be expressed through crying, tantrums, freezing, clinging, shrinking, or failure to speak in social situations
      5. social situations are avoided
      6. significant distress or impairment in social functioning
         1. if performance only: fear is specific to public speaking or performance
   2. most cases seen in ages 8-15 any is more commonly seen in girls because of concern about social competence, and interpersonal relationships
   3. can be a cause of a stressful or humiliating experience or may be unrelated
3. Phobia
   1. Must have all symptoms for at least 6 months
      1. fear or anxiety about an object or event
         1. for kids it may be shown through crying, tantrums, freezing, or clinging
      2. object or event is avoided
      3. distress or impairment in social, occupational, or other important areas of functioning
      4. there are 5 subtypes
         1. animals
         2. natural environment
         3. blood injection injury
         4. situational
         5. other
   2. more common in children and adolescents (7-11 yrs old) and in females
   3. less likely to be resolved if phobia follows into adulthood
4. Generalized anxiety disorder
   1. excessive anxiety or worry occurring for multiple days than not where they find it difficult to control the worry for at least 6 months and must have at least three of the following symptoms (one for children)
      1. restlessness or on edge
      2. easily fatigued
      3. difficulty concentrating or mind goes blank
      4. irritability
      5. muscle tension
      6. sleep disturbance
      7. significant distress or impairment
   2. more common in females
   3. onset rare before adolescence, but if onset is found to be earlier it is more severe
   4. symptoms are on and off but tend to be persistent
   5. kids with GAD are described as little adults (perfectionstic, punctual, eager to please, illusion of maturity)
5. Panic disorder
   1. recurrent panic attacks and at least one of the attacks has been followed by one month of one or both of the following
      1. persistent concern or worry about another panic attacks
      2. significant maladaptive change in behavior because of the attacks
   2. more prevalent in adolescents and adults
   3. more prevalent in girls
   4. if it goes untreated it, more likely to be chronic on and off
6. Major depressive disorder
   1. main symptoms are sadness, anhedonia, and irritability and must have 5 of the following criteria and one has to be depressed mood or anhedonia and only needs to be occurring for 2 weeks to diagnose
      1. depressed mood most of the day nearly everyday
      2. irritable mood
      3. loss of interest or pleasure in all or most everyday activities
      4. significant weight loss or in kiddos it can be a failure to gain weight
      5. insomnia or hypersomnia
      6. agitation or retardation nearly everyday
      7. fatigue or loss of energy everyday
      8. feelings of worthlessness or extreme guilt
      9. difficulties concentrating
   2. 40% recovery begins within 3 months of onset
   3. 80% recovery begins within one year of onset
   4. each episode increases the likelihood of future episodes
   5. 12 month prevalence in the US and it increases risk of suicide
   6. more likely in women
   7. likely to be diagnosed with bipolar later on
   8. having a parent with MDD increases the risk for children
7. Persistent depressive disorder
   1. depressed mood for most of the day on most days for at least 2 years (1 year in children and adolescents)
   2. unhappy or irritable mood most of the time
   3. usually begins gradually where MDD onset is rapid
   4. chronic symptoms but less severe than MDD
   5. 2 years for adults and occuring for at least one year for children and adolescents to get diagnosed, following criteria
      1. poor appetite or overeating
      2. insomnia or hypersomnia
      3. low energy or fatigue
      4. poor concentration or difficulty with decision making
      5. feelings of hopelessness
   6. 12 month prevalence in the US
   7. more common in females

Things to know for all disorders:

• What treatment(s) are the most effective?
  • What are the components of those treatments (e.g. how does cognitive behavioral therapy work, what thoughts are targeted).
    • For Anxiety Disorders
      • Exposure (invivo, imagined, virtual reality)
        • Systematic desentization

development of hierarchy

relaxation techniques

• • • • • Graded exposure (slowly exposing a person to feared stimuli without relaxation techniques)
        • Flooding ( intense exposure until anxiety decreases)
      • CBT ( useful for social anxiety, GAD, and separation anxiety disorder)
        • modify negative thoughts and self talk
        • recognize signs of anxiety

identify cognitive processes associated with anxiety

strategies for managing

FEAR (feeling frightened, expecting bad things to happen, actions/attitudes, results/rewards)

• • • • CBT for panic disorder
        • relaxation training

reduce arousal

• • • • • interoceptive exposure

times of calm, intentionally produce symptoms to understand that they can be intentionally produced, controlled, and they are not life dangering

• • • • • cognitive restructuring

arousal is not catastrophic

• • • • • graded in vivo exposure

for situationally-bound panic attacks)

• • • Depressive Disorders
      • CBT
        • teaches coping strategies
        • plan fun activities
        • cognitive restructuring
        • identifies evidence and alternative explanations
        • what if
        • 70% respond

ACTION

find something to do to feel better

catch the positive

think about it as a problem to solve

inspect situation

open yourself up to the positive

never get stuck in negative mindset

• • • • Combined treatment with CBT + medication is most effective
• How many symptoms are necessary for an official diagnosis (this is only important for questions in which “no diagnosis” might be an answer choice. Probably not many questions like this, but something good to know) Done
• What school-based interventions are helpful for each disorder?
  • Anxiety
    • friends program
      • group based CBT (anxiety prevention program)
      • students are taught skills for coping, emotional recognition, relaxation, etc.
      • 10 weekly sessions, 2 booster sessions
    • cool kids
      • CBT group intervention (7-12 yrs old)
      • 8 weekly sessions (1 hr each)
      • psychoeducation, cognitive restructuring during early sessions)
      • successful when done by professionals
  • Depressive disorders
    • Universal (includes all students with present onset depression to build resilience)
    • selective
    • target at risk student
    • indicated
      • ACTION (for students who already have depression or depressive symptoms)
        • 20 group sessions, 2 individual meetings, and 8 parent training meetings
        • psychoeducation

explanation for treatment and info on the disorder such as causes

building awareness of emotions, false thoughts, and behaviors common in depression( mood thermometer)

• • • • • goal setting

individualized intervention

collaboration with therapist/ professional

emphasizes child's needs

• • • • • coping skills training

behavioral activation

re- engage in things that creative positive moods and interactions

5 strategies: do something fun/distracting, soothing/relaxing, expands energy, talk about it, change thinking mindset

create a list of activities that work and homework is to use these skills

break down problems into 5 stamps

• • • • • cognitive restructuring

we can pay attention to multiple things at once, we have choices, and we ask questions to restructure thoughts (evidence, multiple perspectives, conversations)

parent training

teach parents skills that students are learning to change family environment, promote positive behavior management, family problem solving, change affective tone at home

• • • • • activities to build and maintain positive self concept
• How does a school psychologist determine whether a student qualifies for an IEP under IDEA? How do they determine if a student qualifies for a 504?
  • For Anxiety
    • falls under emotional disturbance for IDEA and only if they experience a disturbance in learning abilities that cannot be explained
    • for and iep the curriculum is changed to accommodate the student but in a 504 plan small supports are offered to help student
  • For Depression
    • falls under emotional disturbance and has to affect educational abilities
    • it has effects on a student by causing low motivation, attendance, memorization skills,recall, concentration, emotional well being, social isolation and anhedonia which undermines learning
    • important to address because it can lead to suicide, substance abuse, academic underachievement
  • For a given set of symptoms/challenges, what might example IEP goals be? What might examples of 504 accommodations be?
    • Ex of IEP goal for Anxiety
      • Goal: Josh will learning strategies to decrease his anxiety from shutting down and refusing to do work 50% of the time to no more than 40% of the time
        • Objective 1: will work with staff to identify when he is feeling anxious 4 out of 5 times and can keep an ongoing list that he can revise when needed
        • Objective 2: will learn strategies to use during high feelings of anxiety and practice them successfully in small groups using role play 5 out of 6 times
        • Objective 3: Josh will use these strategies to decrease anxiety in the classroom as measured by his teacher 4 out 5 times
    • EX of 504 Goal for Anxiety
      • Josh is a student who has recently been diagnosed with an anxiety disorder
        • will have extra time for quizzes/tests, given a separate space to complete exams and will sit in the front and have access to the door
        • will have a back pocket pass to see school nurse when overwhelmed
• If I gave you examples of someone’s IEP goals or 504 accommodations, how could you work backwards to figure out what diagnosis the student might have?

Key Terms:

Anhedonia - feeling little joy and loss of interest in nearly all activities

Dysphoria - prolonged bouts of sadness or irritability

HPA axis

• during anxiety
  • high cortisol = stress hormone
  • sensitivity in the amygdala
  • dysregulation in norepinephrine and decreased levels of serotonin
  • People with anxiety disorders have an overactive HPA axis
• during depression
  • high levels of stress hormones (cortisol)
  • low serotonin, dopamine, and norepinephrine

Serotonin - inhibits the tendency to explore

• regulates eating, sleeping, and aggression
• very important in OCD and depressive disorders

Dopamine - involved in exploratory, extroverted, and pleasure seeking behaviors

• important in depressive disorders and ADHD

Norepinephrine- controls emergency reactions and alarm responses

• regulates emotions and behaviors

IDEA (and relevant categories we’ve discussed)

• makes public education free to students with disabilities and ensures they receive the special education and services needed to help them succeed
• categories that qualify
  • emotional disturbance ( anxiety, depression, ptsd, conduct disorders, and ODD)
  • other health impairments (ADHD)
  • autism
  • intellectual disabilities
  • learning disabilities
  • multiple disabilities
  • hearing impairments
  • developmental delays
  • TBI
  • speech/language impairments
  • visual impairment
  • deaf/blindness
  • orthopedic impairments

504 plan

• plan offered if child doesn’t met IDEA requirements
• must demonstrate a physical/mental impairment that limits at least one major life activity
• a record of impairment must exist and impairment cannot be temporary

Individualized education plan (IEP)

• documents students current functioning level and areas of concerns
• measurable annual goals
• suggests adaptations and interventions to instruction and environment
• provides methods to evaluate goals
• for eligible students a disorder or disability must be affecting their academic performance and this document outlines the services, and modifications needed to help them succeed
• outlines where services will be provided
• must be reassessed every 3 years

Least restrictive environment (LRE)

• students should be in general education class as much as possible in order to feel more involved and build social skills with peers
• will help them develop normally in areas they don’t need more supports in

Free and appropriate education (FAPE)

• everyone has a right to a free and appropriate education regardless of disability

Positive/Negative reinforcement/punishment

• positive reinforcement: adding something to increase/maintain behavior
  • money or praise
• positive punishment: adding something to decrease behavior
  • spanking or scolding
• negative reinforcement: take something away to increase/maintain behavior
  • take away clothes
• negative punishment: take away something to decrease behavior
  • takeaway food

Multifinality

• similar initial pathways lead to different outcomes

Equifinality

• different initial pathways lead to the same outcome

Concordance rate

• percentage of cases in which a characteristic displayed by one individual is also displayed by another
• can be investigated by comparing family members , specifically twins
• helps quantify the genetic component of various traits

Monozygotic/Dizygotic twins

• monozygotic - share 100% of genes
• dizygotic- share 50% of genes

Risk factors

• increase the chances that an outcome will occur
• more risk factors = greater the risk
• a risk factor does not determine which disorder

Protective factors

• reduce the risk and increase resiliency
• more protective factors can reduce chances of receiving a diagnosis

Fear

• immediate reaction to danger

Panic

• sudden uncontrollable fear or anxiety

Anxiety

• strong negative emotion and bodily symptoms of tension in which one apprehensively anticipates danger or misfortune and often a feeling of a lack of control

Modeling/social learning

• behavior can be learned through observation
• behavior is especially liked to be copied if its rewarded

Classical conditioning

Operant conditioning

• reinforcement vs punishment
• punishments are more hostile and aggressive behaviors
• If it does not teach children new, prosocial behaviors, it can lead to abuse

Exposure therapy

• Types of exposure therapy for anxiety disorders
  • Systematic desensitization
    • Development of hierarchy
    • Relaxation techniques
  • Graded exposure
    • Without relaxation techniques (slowly exposes person to feared stimuli)
  • Flooding
    • Intensely exposed until anxiety is lessened

Cognitive behavioral therapy

• Useful for SAD, Social Anxiety Disorder, and GAD
  • Modify negative thoughts and self-talk
  • Recognize signs of anxiety
    • Identify cognitive processes associated with anxiety
    • Strategies for managing
    • FEAR
      • F- feelling frightened
      • E- expecting bad things to happen
      • A - actions and attitudes
      • R- Results and rewards
• CBT for Panic Disorder
  • Relaxation training
    • Reduce arousal
  • Interoceptive exposure
    • In times of calm, intentionally produce symptoms
      • See that symptoms can be intentionally produced
      • See that they will not die or pass out
  • Cognitive restructuring
    • Arousal is not catastrophic
  • Graded in vivo exposure (for situationally-bound panic attacks)
• ADHD
  • What are the three attention deficits?
    • Attentional capacity
      • Amount of info that can be remembered and attended to for a short time (phone number)
    • Selective attention - ability to focus on relevant stimuli and not be distracted by an irrelevant stimuli
    • Sustained attention - ability to maintain persistent focus on a task over an extended period of time
  • What are the three symptoms of ADHD?
    • Inattention
      • Lack of focus on demands/details
      • Careless mistakes, not listening
      • Difficulty in organizing
      • Distracted and forgetful
      • Sluggish, slow to respond, daydreaming, lack of activity and energy
    • Hyperactivity
      • On the go motion
      • Difficulty sitting still and regulating their behavior
      • More active at night
    • Impulsivity
      • Acting without thinking
      • Can be seen as careless, irresponsible, immature, lazy or rude
  • What are the different types of presentations and how many symptoms must they show to be diagnosed?
    • Inattentive Presentation (6 out of 9)
    • Hyperactive- Impulsive Presentation (6 out of 9)
    • Combined (6 attentive and 6 hyperactive-impulsive symptoms)
  • What is DSM-5 Criteria for Inattentive ADHD?
    • Failure to pay close attention to details and careless mistakes
    • Difficulty sustaining attention in activities (lectures, conversations, assignments)
    • Does not seem to listen when spoken to
    • Does not follow directions or completes responsibilities
    • Difficulty organizing tasks, materials, and activities
    • Avoids in engaging in tasks that require sustained mental effort
    • Loses items for tasks and activities
  • What is DSM-5 Criteria for Hyperactive- Impulsive ADHD?
    • Fidgets or squirms in seat
    • Difficulty remaining in their seat
    • Runs about or climbs when it is inappropriate
    • On the go behavior
    • Talks excessively
    • Blurts out answers beforing a question has been completed
    • Difficulty waiting for their turn
    • Interrupts or intrudes others
  • What criteria does one have to meet to be diagnosed with ADHD?
    • Symptoms must have been occurring before the age of 12
    • Multiple symptoms must occur in at least 2 settings
    • Negatively impacts social and academic/occupational activities
    • For older adolescents or adults they have to show they have at least 5 of the required symptoms
    • Cannot be a relation to another mental disorder
  • What characteristics are seen in those who have ADHD?
    • Social behavior/Relationships
      • 56-76% have no mutual friendships are those with inattentive are more likely to be neglected by peers and those with combined are more likely to be rejected by peers
    • Health, sleep, accidents
      • Have difficulty sleeping and have a higher accidental injuries
    • Executive Functioning
      • Deficits in cognitive processes, verbal self regulation, inhibition, and planning
    • Adaptive Functioning
      • Low self care and independence
    • Academic achievement
      • Many have learning disabilities
  • Who is more likely to be diagnosed with ADHD?
    • More common in boys but girls are more likely to present with inattentive features
    • More likely in childhood than adolescence, most are diagnosed in childhood
  • What is the prognosis of ADHD?
    • Hyperactive symptoms are less obvious in adolescence and adulthood but other difficulties may persist
    • Children with ADHD remain relatively impaired into adulthood
  • What are the causes of ADHD?
    • Neurobiology
      • Front lobe
    • Transmitters
      • Low dopamine and norepinephrine
    • ADHD runs in families and children
    • Birth complications and prenatal risk
      • Low birth weight or injury
      • Prenatal smoking and alcohol
    • Psychological Influences
      • Family factors are most influential
      • Bidirectional: more hostile-intrusive parenting
  • What are treatments for ADHD?
    • There medications to manage treatments such as stimulants which can increase dopamine/norepinephrine activity (Adderall and Ritalin)
    • They are most effective in school aged children and somewhat effective for older children and adolescents
    • Not a permanent fix and in some cases 10-20% non effective for children
    • Can lead to side effects in sleep appetite, pains, irritability and jitteriness
    • Psychological Treatments
      • Behavior Management
        • More focus on key functional domains (social relationships and school performance
        • Immediate and tangible rewards
      • Parent Training (PT)
        • Bring behavior under parental controls where desirable behaviors are strengthen, clear expectations are set, and they are consistently being disciplined
        • Can improve parent- child relationships
      • Multimodal Psychosocial Therapy (MPT)
        • Mixture of parent training, school intervention, contingency management/ behavior intervention, summer session
    • 66% of kids 4-17 receive medications, 64% receive school support, 32.5% receive psychosocial treatment
  • What recommendations does the American Academy of Pediatrics make for students with ADHD?
    • Preschool- Behavioral treatment
    • Elementary- medication or behavioral treatment
    • Adolescents - medication and/or behavioral treatments
  • What category does ADHD fall onto?
    • Other health impairment (OHI)
  • What behavioral techniques are recommended for ADHD?
    • Praise (positive/negative reinforcement or punishment)
    • Ignore/punish unwanted behavior
    • Clear commands/expectations
      • Define alternative behaviors
    • One or two step directions only
    • Catch the child being good (5:1 ratio)
    • Token economy (short + long term rewards)
  • What classroom structure works for ADHD students?
    • Opportunities for engagement
    • Peer tutoring
    • Cooperative learning groups
    • Self - correction
    • Student sits close to teacher and to peers who are attentive and away from distractions
    • Visual reminders of task +expectations
    • Space between desks
  • What teacher strategies are useful for ADHD?
    • Nonverbal support to help student recognize a certain behavior in order to help them manage response
    • Give choices
    • Set reminders to help the student “self-check”
    • Prime to remind student about goals, expected behaviors, and rewards
    • Proximity ( stay close to student during difficult activities)
    • Timers
• Conduct Disorders
  • What are conduct problems related to?
    • Antisocial behavior
      • Inappropriate actions, attitudes that violate family expectations, social norms, personal or property rights
    • What is the legal term for antisocial behavior?
      • Delinquency ( not necessarily a mental disorder)
    • What are key features of antisocial behaviors?
      • Some behaviors can decrease with age
      • Some behaviors may increase with age and opportunity
      • More common in boys during childhood
    • What is reactive aggression?
      • Engaging in physical violence in response to an event
      • Usually impulsive with no consideration of alternative responses
      • Seen in younger kids with ADHD
    • What is proactive aggression?
      • Deliberately engaging in aggressive act to obtain a desired goal
    • What are the most common childhood/adolescent conduct disorders?
      • Intermittent explosive disorder (IED)
      • Oppositional defiant disorder(ODD)
      • Conduct Disorder (CD)
  • What is IED and the criteria?
    • Recurrent behavioral outbursts leading to failure to control aggressive impulses as manifested by
      • Verbal aggression (verbal fights/arguments) or physical aggression toward property, animals, or individuals that occurs twice a week on average for 3 months
        • Physical aggression does not lead to damage or destruction of property or injury to animals or individuals
      • Three behavioral outbursts that include damage or destruction of property and/or physical assault involving physical injury against animals or individuals within a 12 month period
    • Aggressiveness/outbursts are out of proportion and are not premeditated or done to achieve an objective
    • Recurrent aggressive outburst caused distress to individual or impairment in their occupational or interpersonal functioning or can lead to financial/legal consequences
    • Age 6 or older
    • Recurring aggressive outburst are not in relation to another mental disorder
  • When is IED more prevalent?
    • 4% prevalence and more likely to begin in later childhood/ adolescence
    • Tend to be chronic and persistent over the years and no gender differences exist
  • What is Oppositional Defiant Disorder (ODD) and its criteria?
    • Pattern of angry/irritable mood, argumentative, defiant behavior or vindictiveness that lasts for about 6 months and have 4 of the following categories with a person that is not a sibling
      • Angry/ irritable
        • Quick to lose temper
        • Easily touchy or annoyed
        • Often angry and resentful
      • Argumentative/ defiant behavior
        • Often argues with authority figure
        • Often argues with authority figures or adults
        • Intentionally annoys others
        • Often blames others for their mistakes or inappropriate behavior
      • Vindictiveness
        • Spiteful or vindictive at least twice within the last six months
    • Persistence and frequency should be observed to distinguish from a normal behavior and for children under 5 it must happen once per week for at least 6 months
  • What are other characteristics of ODD?
    • They do not seem themselves as angry or defiant instead they believe their behavior is justified
    • May have a history of hostile parenting
  • Who is ODD more prevalent for?
    • 3%
    • Males prior to adolescence
    • First symptoms show up in preschool and it's rare for it to show later than early adolescence
    • Can often precede the development of conduct disorder
  • What is Conduct Disorder (CD)?
    • A repetitive and persistent pattern of behavior in which major basic rights of others or age appropriate social norms/rules are violated
    • Must demonstrate 3 of the following 15 symptoms for the past 12 months with at least one criteria in the last 6 months
      • Aggression to people and animals
        • Bullies, threatens or intimidates others
        • Initiates physical fights
        • Has used a weapon that can cause serious physical harm to others
        • Has been physically cruel to people
        • Has been physically cruel to animals
        • Has stolen while comforting a victim (mugging, purse snatching, armed robbery)
        • Has forced someone into sexual activity
      • Destruction of property
        • Has deliberately engaged in fire setting with the intentions of causing serious damage
        • Intentionally has destroyed others’ property
      • Deceitfulness or theft
        • Has broken into others’ physical properties such as houses, cars, or buildings
        • Often lies to obtains good or favors from others or to avoid obligations
        • Has stolen items of nontrivial value without confronting a victim (shoplifting, but without breaking and entering, forgery)
      • Serious violations of rules
        • Often stays out at night despite parental prohibitions, must be occurring before the age of 13
        • Has often runaway from home overnight at least twice while living with parents without returning for a lengthy period
        • Often truant from school before the age of 13
  • Who is most likely to have CD?
    • 4%
    • Prevalence rates rise from childhood to adolescence
    • Significant symptoms emerge in middle childhood to middle adolescence
    • Onset rare after 16 yrs
    • Few children diagnosed with CD receive treatment
    • Individuals with onset in adolescence and with mild symptoms often achieve adequate adjustment as adults
  • How to differentiate ODD and CD?
    • ODD
      • Argumentativeness
      • Noncompliance with rules
    • CD
      • Significant physical aggression
      • Significant destruction of property
      • Pattern of theft and deceit
  • How to differentiate between ODD/CD and ADHD?
    • ADHD
      • Individuals with ADHD do not mean to cause any harm
    • ADHD and ODD often co-occur
  • How is IED and DMDD differentiated?
    • In DMDD negative mood persits between outbursts whereas in IED there is normal behavior and mood between events
  • What are potential causes for antisocial behavior?
    • Low serotonin levels
    • Low levels of autonomic arousal
      • Underarousal of HPA axis
        • May explain lack of empathy or emotional reactivity to others
        • Limited ability to feel fear and guilt
        • Sensitivity to punishment
        • Lower heart rate + skin conductance
    • Cognitive Behavioral
      • Rewards for aggression
      • Hostile attribution bias
        • Perceive ambiguous behavior as hostile
      • Social learning
        • Modeling new aggressive behaviors
      • Reinforcement trap
        • Giving into a child’s tantrum
  • What treatments are recommended for antisocial behavior?
    • Parent Management Training (PMT)
      • Teach parents the causes of disruptive behavior
      • Teachers parents how to praise appropriate behavior immediately and consistently
      • How to structure environment to help children behave
      • Pros
        • Functioning similar to peers with conduct problems
        • Seems effective even when deprived by nonexperts
      • Cons
        • Potentially less effects for parents under high stress
        • Potentially less effective for older children/ adolescents
    • Parent Child Interaction Therapy(PCIT)
      • Parents and children attend therapy together
      • Provider gives real time coaching through bug in ear ear and 1 way mirror
      • Parents create more realistic expectations for their child’s behavior
        • Give effective and clear commands that are followed by praise or discipline
      • Pros
        • Improvements are maintained for at least 1-2 yrs
      • Cons
        • Best for young children (2-7) less helpful for preteens and teens
    • Multisystemic Treatment (MST) - targets family, school, and peers
      • Therapists work in teams of 3-5 and available 24/7
      • Family
        • Help parents effectively interact and monitor kids
      • School
        • Increase parental involvement
      • Peers
        • Limit opportunities for interactions with deviant peers
        • Increase interactions with prosocial youths/ new peer networks
      • Lowers probability of of future offenses and arrests
      • Very costly
  • Under what category of IDEA do ODD, CD, and IED fall under IDEA?
    • Emotional disturbance
  • What are critical classroom considerations for antisocial behavior?
    • Structured environment
      • Routines
      • Expectations
    • Reinforcement rich environment
      • 5:1 ratio
    • Calm teacher
      • No yelling
  • What is an example of a 504 plan for ODD?
    • Parents and staff will model and promote appropriate self advocacy skills for J and encourage expression of feelings with out fear or retaliation
  • What is an example of IEP for conduct problems?
    • During 20 minute academic task, Sarah will respond to staff directives in an expected manner within 1 minute and with one reminder on 4 out 5 trials
• Autism Spectrum Disorder
  • What is autism?
    • Severe and pervasive impairment in various areas of functioning
  • What are key features of ASD?
    • Deficits in social communication
    • Restricted interests/repetitive behaviors
  • What is DSM criteria for ASD?
    • Persistent deficits in social communication and social interaction across multiple contexts as manifested by the following symptoms
      • Deficits in social emotional reciprocity
        • Failure to initiate or respond to social interactions
      • Deficits in nonverbal communication behaviors
        • Poorly integrated verbal and nonverbal communication to abnormalities in eye contact or body language, lack of use of gestures or facial expressions
      • Deficits in developing, maintaining, and understanding relationships
        • Difficulties in adjusting behavior to social contexts
        • Difficulties in sharing imaginative play or in making friends
        • Absence of interests in peers
    • Restricted repetitive patterns of behavior, interests, or activities by showing two of the following criteria
      • Repetitive motor movements, use of objects, or speech
      • Insistence on sameness, inflexible adherence to routines, patterns of verbal and nonverbal behavior
      • Highly restricted, fixated interests that are abnormal in intensity or focus (ex. Strong attachment to unusual objects)
      • Hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment (ex. Visual fascination with lights or movement)
    • Symptoms must be present in the early developmental period (may not fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life
    • Symptoms cause significant impairment in social, occupational, or other important areas of current functioning
    • Can vary between mild to severe
  • What are some examples of deficits in social communication for ASD?
    • Social emotional reciprocity
      • Sharing interests, affect, emotions
    • Nonverbal communication
      • Eye contact, gestures, facial expressions
    • Interpersonal relationships
      • Interest in others, making and keeping friends
  • What are examples of restricted, repetitive behaviors, interests, and activities?
    • Stereotyped or repetitive behaviors
      • Ex. flapping hands
    • Excessive adherence to routines or resistance to change
      • Tantrums whichever plans are changed or activities altered
    • Restricted fixated interests
      • Excessive interests in bus schedules, cars, trains, etc
      • Difficulties talking about anything else
    • Hyper or hypo reactivity to sensory input
      • Hyper = cannot hear a flush within covering ears and noise
      • Hypo = craves deep touch, heavy weight
  • When is a child typically diagnosed with Autism?
    • Around 3-4 years (depends on geographic region)
    • A diagnosis can be made as early as 24 months
    • Symptoms are usually observed within first 2 years of life
      • Child will seem aloof, distant and avoidant,
      • Only speaking a few words and low eye contact
    • Diagnostic stability increases between 12-24 months
  • What symptoms are typically seen around 12-18 months?
    • Reduced time looking at face and interacting with caregivers
    • Unresponsiveness when their name is being called
    • Little shared attention
  • What are 3 factors in prognosis
    • Intellectual ability
      • Positive: cognitive abilities in average range
      • Negative: intellectual disability (ID)
    • Linguistic abilities
      • Positive: Functional language skills by age 5
      • Negative: lacking language skills by start of school
    • Social engagement
      • Positive: some capacity for joint attention
      • Negative: low motivation for social engagement
  • What category of IDEA does Autism fall under?
    • Autism Spectrum Disorder
  • What is an example of an IEP goal for Autism?
    • By 6/12/2, Rachelle will identify various emotional states in others 4 out 5 opportunities to do so as measured by her counselor
  • How do IEP goals get met for autism?
    • No cure or medication that targets core symptoms
    • Behavioral strategies have the most evidence
      • Applied Behavioral Analysis (ABA)
  • What is ABA?
    • Uses scientific principles of learning and motivation to teach
    • Core concept: consequences of what we do affect what we will do in the future
    • Behavior serves a purpose and is learned
    • An effective method of communication
    • Future frequency is determined by history of consequences
    • If consequences increase future frequency of behavior: reinforcement occured
    • If consequence decreases future frequency of behavior: punishment occured
    • ABC’s
      • Antecedent
      • Behavior
      • Consequence
  • What is the major principle of ABA?
    • Behavior can be influenced by what happens before it and what happens after it
  • What are challenging behaviors in this strategy
    • Aggression, self- injury, self-stimulatory behavior, tantrums
    • Autism is not the cause of bad behavior
  • What assumptions does ABA assume about challenging behavior?
    • Assumes that children are getting something they want from challenging behavior (toys, food, attention, etc.)
  • What 3 steps are needed to address and minimize challenging behaviors?
    • First step is to do a functional assessment
      • What is a student getting out of committing that behavior?
      • DO not give child what they want anymore when they engage in challenging behaviors
      • Teach the child a more appropriate behavior that will get them what they want
  • What behavioral teaching strategies are included in ABA programs?
    • Discrete Trial Training (DTT)
    • Pivotal Response Training/Treatment (PRT)
  • What is discrete trial training?
    • Breaks down learning opportunities into well-controlled, discrete teacher-student interactions
      • Instruction → Correct Response→ Reward
      • Instruction→ Incorrect Response → Correction
  • What is Pivotal Response Training?
    • Teach in the natural environment
    • Wait for child to initiate
    • Prompt the correct behavior
    • Reinforce it
  • Why is PPT better?
    • More natural approach
    • Less structured
    • Looks more like typical skills
    • Great for establishing generalization of skills to new environments (great for teaching play and social skills)
• What is PTSD?
  • Intrusion, avoidance, negative cognitive and mood states, and arousal following a traumatic event which is an event occurring outside from everyday activities that bring distress
  • Symptoms must be occurring for at least a month
• What is the criteria for PTSD for children and adults ( 6 and older)?
  • Exposure to actual or threatened death, serious injury or sexual violence in one of the following wats
    • Directly experiencing the event(s)
    • Witnessing the events in person occurring to other individuals (especially the case for primary caregivers)
    • Learning about these events happened to a close family member or friend. Event must have been violent or traumatic
    • Repeated or extreme exposure to details of the traumatic events (common in first responders, police offers)
  • Presence of 1 intrusion symptoms related to traumatic events after is has occured
    • Recurrent, involuntary, and intrusive distressing memories of the traumatic event
    • Recurrent distressing dreams related to the traumatic event
    • Dissociative reactions in which a child is feeling or reliving the event (ex. flashbacks) in severe circumstances it may caused loss of awareness and can occur in play
    • Intense or prolonged psychological distress at exposure to internal or external cues that resemble an aspect of the traumatic event
    • Psychological reactions to reminders of the traumatic event
  • Persistent avoidance of stimuli associated with traumatic events, beginning after the event, must have one or both of the following
    • Avoidance of or efforts to avoid activities, places, or physical reminders that may arise feelings or thoughts regarding the event
    • Avoidance or efforts to avoid people, conversations, or situations that arise thoughts or feelings of the event
  • Negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after evidence which is demonstrated in 2 or more of the following:
    • Inability to remember important aspects of the event due to dissociative amnesia rather than injury or alcohol/drugs
    • Persistent and exaggerated negative beliefs about expectations of themselves and others in the world (ex. I am bad and no one can be trusted)
    • Persistent, distorted cognitions about the cause or consequences of the traumatic event that leads the person to blame themselves or others
    • Decrease in interest or participation in significant activities
    • Feelings of detachment or estrangement from others
    • Persistent in ability to experience positive emotions
  • Marked alterations in arousal and reactivity associated with the traumatic events, begins or worsens after the evident and is evident by two or more of the following:
    • Irritable behavior and angry outburst (for no reason) can be expressed as in verbal or physical aggression towards people or objects
    • Reckless or self-destructive behavior
    • Hypervigilance
    • Exaggerated startle response
    • Problems with concentration
    • Sleep disturbance
  • Disturbances (B-E) must be occurring for more than a month
  • Disturbance causes distress or impairment in areas of functioning such as social and occupational
• What is the prevalence and prognosis of PTSD?
  • Lifetime prevalence for adolescents: 5-8%
  • Individuals first meet criteria for acute stress disorder before criteria for ptsd
  • 50% of adults recover within 3 months and others remain symptomatic for 12+ months (up to many years)
• What is the criteria for acute stress disorder?
  • Exposure to actual or threatened death, serious injury, or sexual violation in one or more of the following ways:
    • Directly experiencing the traumatic event
    • Witnessing it in person occurs to others
    • Learning about these events happened to a close family member or friend. Event must have been violent or traumatic
    • Repeated or extreme exposure to details of the traumatic events (common in first responders, police offers)
  • Presence of nine or more of the following symptoms from any of the five categories. Symptoms must be beginning or worsening after the traumatic experience occured:
    • Intrusion symptoms
      • Recurrent, involuntary, and intrusive distressing memories regarding the traumatic event
      • Recurrent distressing dreams related to the event
      • Dissociative reactions in which the individual feels or acts as if the traumatic events were occurring in
      • Tense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize ore resemble an aspect of the traumatic events(s)
    • Dissociative symptoms
      • Altered sense of the reality of one’s surrounding or oneself
      • Inability to remember an important aspect of the traumatic event(s) due to dissociative amnesia
    • Avoidance symptoms
      • Efforts to avoid distressing memories, thoughts or feelings about or associated with the traumatic event
      • Efforts to avoid external reminders (people, places, feelings and objects) that bring about memories, thoughts or feelings associated with the event
    • Arousal symptoms
      • Sleep disturbance
      • Irritable behavior and angry outburst as seen with verbal or physical aggression
      • hypervigilance
      • Difficulty concentrating
      • Exaggerated startle response
  • Duration of the disturbance is 3 days to 1 month after trauma experience, symptoms may immediately appear after trauma
  • Disturbance causes distress or impairment in areas of functioning such as social and occupational
• What is the prevalence and prognosis of acute stress disorder?
  • Less than 20% of cases trauma did not include assault
  • Higher rates (20-50%) reported after interpersonal trauma
  • Higher rates among females than boys
• What factors cause PTSD despite it being unclear why some children develop ptsd and others don’t?
  • Previous trauma
  • Loss of family member, friend or pet
  • Separation from caregivers
  • Physical injury
  • Relationships with family members cultural differences
• What IDEA category does PTSD and Acute Stress Disorder fall under?
  • Emotional disturbance
• What is the cycle of trauma?
  • Trauma → Emotional/Psychological Damage → Behavioral Problems→ Punishment
  • This cycle repeats
• What are problematic behaviors in the classroom associated with these two disorders?
  • reactivity/impulsivity
  • Aggression
  • Defiance
  • Withdrawal
• What are protective factors for these disorders?
  • Three factors associated with predicting overall resilience
  • Trauma disrupts these factors but they can be used to help children who have experienced trauma
    • Family
      • Strong parent-child relationship (can also be with a mentor or caregiver)
    • Individual
      • Good cognitive skills, ability to self regulate
    • Community
      • Connections to community/ strong schools
• How can schools help students with these disorders?
  • School wide considerations
    • Balance accountability with knowledge of trauma
    • Rules vs. abuse
    • Positive behavioral support
    • Consistency
    • Model appropriate behavior
  • Classroom considerations
    • Find “islands of competence”
    • Predictability (schedule)
    • Safety
• What are academic instruction strategies for students who have experienced trauma?
  • Building on students individual strengths and interests
  • Maintaining routines
  • Clear and manageable expectations
  • Language based teaching approaches
  • School evaluations
  • Build nonacademic relationships with students
  • Support and facilitate participation in extracurricular activities
  • Minimize disruptions
  • Model respect
  • Open communication with guardians, parents, and or caregivers
• What are obsessions?
  • Persistent and intrusive thoughts, ideas, impulses or images
• What are compulsions?
  • Repetitive, purposeful and intentional behaviors or mentals acts that performed in response to an obsession
• What is the criteria for OCD?
  • Presence of both obsessions and compulsions
  • Obsessions are defined as
    • Recurrent and persistent thoughts, ideas or images, that are experienced as some time during the disturbance as intrusive and unwanted, cause either anxiety or distress
    • Individual attempts to ignore or suppress thoughts, urges, or images or to neutralize them with some other thought or action
  • Compulsions are defined as
    • Repetitive behaviors or mental acts that individual feels driven to perform in response to an obsession or according to applied rules
    • Behaviors or mental acts are aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation however they’re not connected in a realistic way to what they are designed to neutralize or prevent
    • Young children may not be able to articulate the aims of these behaviors or mental acts
  • Obsessions or compulsions are time consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • Obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition
  • Disturbances are not caused by symptoms of other disorders
• What are the different types of insight?
  • Good/fair insight: individual recognizes their obsessive-compulsive beliefs are definitely or probably not true
  • Poor insight: individuals thinks that obsessive-compulsive beliefs are probably true
  • Absent/Delusional insight: individual is completely convinced that obsessive-compulsive disorder beliefs are true
• Does OCD require a certain duration of symptoms for a diagnosis
  • NO
• What is the prevalence for OCD?
  • 12 month prevalence in adults 1-2%
  • 25% in 5-15 year olds
  • More common in boys in childhood and even more so by adulthood
  • Kids keep this a secret (90% untreated)
• What is the prognosis of OCD?
  • Meant onset age = 19.5
  • 25% of cases start by the age of 14
  • 25% of males have onset before the age of 10
  • Gradual onset common
  • If it goes untreated than usually chronic
    • Remission rates in adults are low (20% 40 years later)
    • 40% with onset in childhood/adolescence may experience remission
• What trends do we see with OCD and suicide?
  • 44% experiences suicidal ideation and 14% attempt
  • Increase in both if an individual has depression or anxiety
• What are the differences between OCD and anxiety disorders?
  • Fear, panic, or worry are not primary symptoms in OCD
  • Different cognitive parents
    • Thought- action -fusion - that belief that simply thinking about an action is equivalent to performing it
    • Makes people feel responsible for events outside their control
• What are the causes of OCD?
  • Moderately heritable
    • Twice as likely to have this disorder if you have a first degree relative with OCD
    • If relative develops OCD in childhood/adolescent then 10x more likely
    • Concordance rate for identical twins in .57 and .22 for fraternal twins
  • Compulsions are negatively reinforced
• What are treatments for OCD?
  • CBT
    • Exposure and response prevention
    • Most respond but not all
    • CBT+ medication may work best for most
• What category of IDEA does OCD fall under?
  • Emotional disturbance
• What symptoms of OCD interfere with learning/school performance?
  • Obsessions and compulsions are distractors
• Ex. of IEP goals for OCD
  • Reduction in the amount of time spent focused on obsessive thoughts and performing compulsive behaviors
    • Student will identify the relationships between obsessions and compulsions on 4/6 occasions by September 2023
    • Student will perform at least one new activity previously prevented by her OCD by September 2023
• What are accommodations for students with OCD?
  • Allow students to use tape recorder for assignment
  • Allow students to be first to get handouts and pass to others
  • Untimed tests or in an alternative location