Child Psychopathology 2nd Test

Anxiety Disorders

many forms "excessive and debilitating anxieties" Maris article-- "The pathogenesis of childhood anxiety disorders: considerations from a developmental psychopathology perspective": - genetics are definitely a risk factor- anxiety disorders definitely can be passed genetically. Behavioral inhibition can also be genetic - "Behavioral inhibition is a temperamental trait characterized by the tendency to be unusually shy and to react with fear and withdrawal in situations that are novel and/or unfamiliar. Research has shown that behaviorally inhibited children and adolescents are at increased risk for developing anxiety disorders." Thus, behavioral inhibition is a risk factor for anxiety disorders. - Disgust sensitivity "is a genetically based personality trait that should be viewed as a specific vulnerability factor as it is only relevant for certain types of anxiety disorders. More precisely, disgust sensitivity seems to be involved in the pathogenesis of childhood phobias, and in particular animal phobias." - Negative learning experiences are an important part of how anxiety disorders might develop. --Rachman's 3-pathways theory: "this theory posits that anxiety phenomena are acquired three ways: (a) classical conditioning, (b) observational learning or modeling, and (c) negative information transmission)." - Protective factors against anxiety disorder development in kids might be: --Effortful control: "effortful control refers to regulative, executive functioning-based process, which include the focusing and shifting of attention (i.e., attentional control) and the ability to inhibit behavior when appropriate" -- Perceived control: "early experiences with diminished control may foster a cognitive style characterized by an increased probability of interpreting and processing subsequent events as being out of one's control, which may represent a psychological vulnerability for anxiety. The other way around, early experiences of adequate control may instill a cognitive style that is marked by certainty about the ability to control one's environment, which may serve as a buffer to anxiety." -- self esteem and self-efficacy are also protective factors - "Maintaining Factors" --i.e. factors that may maintain or intensify an anxiety disorder --Mowrer's 2-stage model: "suggests that avoidance behavior is responsible for the maintenance of anxiety problems. More precisely, avoidance would minimize direct and prolonged contact with the fear-provoking stimulus or situation, and, hence, the anxious child would not have the opportunity to learn that the stimulus or situation is in fact harmless or safe. While the role of avoidance behavior in the maintenance of anxiety disorders seems self-evident, there are also a number of cognitive distortion that promote continuation of these psychopathological problems. Cognitive distortions refer to cognitive processes that are biased and erroneous and therefore yield dysfunctional and maladaptive thoughts and behaviors. Typically, in anxiety disorders, such distortions reflect the chronic overactivity of schemas organized around themes of danger and threat." --Threat perception biases: ---interpretation bias: "refers to anxious children's tendency to disproportionately impose negative interpretations upon ambiguous situations" - "Research has shown that normal fear and anxiety follow a predictable course: in infancy, children become fearful and anxious of imaginary creatures (e.g., ghosts, monsters) and stimuli in their immediate environment, but as the child matures these emotions begin to incorporate anticipatory events and stimuli of an abstract nature. It is assumed that this developmental pattern of fear and anxiety reflects everyday experiences and to an important extent is mediated by children's cognitive capacities." - the types of fears children have are determined by where they are developmentally - cognitive development can be both a risk factor and a protective factor. Kids can be more vulnerable to anxiety disorders during major developmental periods, but during these same periods they may gain more resilience and protection against these disorders. - anxiety disorders do not have just one cause - anxiety disorders manifest as maladaptive behaviors and thought patterns, etc... Article: "Understanding the Anxious Mind" by Robin Marantz Henig-- from the New York Times -Psychologist Jerome Kagan did a study of infants to study whether those who reacted strongly and negatively to new stimuli were more at risk for developing anxiety disorders. - Baby 19 was his breakthrough, because her temperament was easily upset and she then grew up to have an anxiety disorder - "in people born with a particular brain circuitry, the kind seen in Kagan's high-reactive study subjects, the amygdala is hyperreactive" - the amygdala is the part of the brain that "responds to novelty and threat" - Kagan also did work studying behaviorally inhibited kids. Kagan and his colleagues hypothesized that "the inhibited children were 'born with a lower threshold' for arousal of various brain regions, in particular the amygdala, the hypothalamus and the hypothalamic-pituitary-adrenal axis, the circuit responsible for the stress hormone cortisol" - Kagan found as he continued his work that highly reactive babies become behaviorally inhibited children a lot of the time, who then become anxious older children, teens, and adults. - the temperament-environment-other factors interaction is very important - high reactives can and often are also very high achieving, but they also often tend to be very anxious too - Scientists also found that high-reactives tend to have thickening in the prefrontal cortex, which might mean a difference in brain functioning for these individuals. A thin cortex may also be seen (in the case of Baby 19, it was, and this is what I refer to). Article: "Parental Perfectionism and Overcontrol: Examining Mechanisms in the Development of Child Anxiety" by Nicholas W. Affrunti and Janet Woodruff-Borden. - found that "parents with higher levels of anxiety and higher levels of perfectionism. Higher levels of perfectionism were associated with increased use of over controlling behaviors. Increased parental over control was associated with increased child anxiety severity." - "Findings suggest that parental perfectionism and parent use of over control are mediators of the relationship between parent and child anxiety."

"Normal fears, anxieties, worries, and rituals"

"the number and types of common childhood fears change over time, with a general age-related decline in number" "like fears, anxieties are very common during childhood and adolescence" Different anxieties arise and go away at different times. Some worries are also normal, and young children can normally have rituals and repetitive behaviors.

School refusal behavior

"the refusal to attend classes or difficulty remaining in school for an entire day"

Positive Affectivity

"refers to a persistent positive mood that includes states such as joy, enthusiasm, and energy" "negatively correlated with depression but is independent of anxiety symptoms and diagnoses"

Psychological dependence

"refers to the subjective feeling of needing the substance to adequately function"

Early Theories of Anxiety Disorders: Classical Psychoanalytic Theory

"views anxieties and phobias as defenses against unconscious conflicts rooted in the child's early upbringing"

Panic Disorder

connected to agoraphobia, but they are their own disorders "recurrent unexpected panic attacks followed by at least 1 mont of persistent concern or worry about having another attack and its consequences or a significant change in their behavior related to the attacks in order to avoid having them.

Anxiety-- physical system

sympathetic nervous system activation activated by anxiety, fear, fight/flight response, etc... chemical cardiovascular respiratory sweating other somatic symptoms

"with limited prosocial emotions"

term used by the DSM-5 "to describe youth with CD who display a persistent and typical pattern of interpersonal and emotional functioning involving at least two of the following three characteristics: lack of remorse or guilt; callous-- lack of empathy; and unconcerned bout performance. The term 'limited prosocial emotions' was used, in part, in DSM-5 to avoid the possible negative connotations associated with the term 'callous-unemotional;'".

Anxiety-- behavioral system

the behaviors that are exhibited when anxiety is being experienced, including avoidance.

Early Theories of Anxiety Disorders: Behavioral and Learning Theories

"held that fears and anxieties were learned through classical conditioning." "Operant conditioning has been cited in explaining why fears persist once they are established. The principle is that behavior will continue if it is reinforced or rewarded" two factory theory: "the combination of classical and operant conditioning in the learning and maintenance of fears"

Associated characteristics of SUDS

"Among adolescents who fit criteria for substance-use disorder, many related symptoms and behaviors have been noted. Thee youths tend to use more than one drug simultaneously, with marijuana and alcohol the most common combination, followed by alcohol and hallucinogens. They also have problems of related to poor academic achievement, higher rates of academic failure, higher rates of delinquency, and more parental conflict." "Emerging research also suggests that heavy drinking may be physically more dangerous at 15 years of age than a few years later at age 20, because it may disrupt or disturb ongoing neurodevelopmental processes of myelination and synaptic pruning. As compared with teens with lower substance-use levels, teens with histories of heavy drinking performed poorly on tests of memory and attention, in addition to exhibiting other signs of abnormal neurological development. The adolescent hippocampus may be particularly susceptible to alcohol, potentially because of an interaction between adolescent brain development and alcohol exposure"

Associated Characteristics of Conduct Problems

"Cognitive and Verbal Deficits" - kids with CD tend to score lower on IQ tests --they especially tend to have lower "verbal IQ" "suggesting a specific and pervasive deficit in language". This may lead to academic problems as well as learning problems, and also may be part of what causes the conduct problems in the first place (bit of a chicken and egg thing, it seems like). - they also tend to be very impulsive. - also executive functioning deficits are found in kids with CD and ODD "School and Learning Problems" - kids with CD and ODD often have problems in school and with learning - they are often held back, placed in special ed, drop out, etc... - a combination of "disruptive behavior" and the aforementioned cognitive difficulties also come into player. More frustration etc.... leads to the greater likelihood of issues with school "Family Problems" - "General Family disturbances" --"include parental mental health problems, a family history of antisocial behavior, marital discord, family instability, limited resources and antisocial family values" -"Specific disturbances in parenting practice and family functioning" --"include excessive use of harsh discipline, lack of supervision, lack of emotional support and involvement, and parental disagreement about discipline" - The aforementioned "two types of family disturbances" that we see in the families of kids with CD "are interrelated, since general family disturbances such as maternal depression often lead to poor parenting practices that can lead to antisocial behavior and feelings of parental incompetence that may lead to increased maternal depression, which completes the circle" - "high levels of conflict are common in families of children with conduct problems. So, too, are poor parenting practices such as ineffective discipline, negative control, inappropriate use of punishment and rewards, failure to follow through on commands, and a lack of involvement in child rearing. Parents may also exhibit social-cognitive deficits similar to those of their children, which suggests that the tendency of antisocial children to infer hostile intent of others may mirror the social perceptions of their parents. Finally, there is often a lack of family cohesion, which is reflected in emotional detachment, poor communication and problem solving, low support, and family disorganization. Household chaos-- characterized by high noise levels, crowding, people coming and going all the time-- and a lack of predictability and family routines is also associated with child conduct problems." - Sibling conflict has also been studied. "The collaboration of siblings in one another's deviant behavior can be as powerful as deviant peer relationships in heightening the risk for later conduct problems, and may also contribute to later aggression toward peers." "Peer problems" - "young children with conduct problems display verbal and physical aggression toward other children as well as poor social skills. Preschoolers who show poor self-regulation have difficulty understanding the perspectives of others, experience corporal punishment from their parents, and display higher levels of peer aggressiveness during the transition to grade school. As they grow older, most children with conduct problems are rejected by their peers, although some may remain quite popular. Peer rejection in elementary school is a strong risk factor for adolescent conduct problems" - Kids with conduct problems can also become bullies as they progress through school - although kids with conduct problems can make friends, they often make friends with "like-minded antisocial individuals". These kinds of friendships are "a powerful predictor of conduct problems during adolescence." "Involvement with antisocial peers becomes increasingly stable during childhood and supports the transition to adolescent criminal acts such as stealing, truancy, and substance abuse." - aggressive kids who are reactive-aggressive ("showing an angry defensive response to frustration or provocation") often have a hostile attributional bias ("which means they are more likely to attribute hostile and mean-spirited intent to other children, especially when the intentions of others are unclear"). On the other hand, proactive aggressive children ("those who use aggressive behavior deliberately to obtain a desired goal") "are more likely to view their aggressive actions as positive and to value social goals of dominance and revenge rather than affiliation. Proactive-aggressive children display a lack of concern for others; and their solutions to social problems are few in number, mostly aggressive, and inappropriate. Proactive-aggressive youths are also likely to display reactive-aggression, whereas reactive-aggressive youths display only reactive aggression and are less aggressive overall." "Self-esteem Deficits" - a lot of kids with conduct problems have low self esteem "Health-Related Problems" - "young people with persistent conduct problems engage in many behaviors that place them at high risk for personal injuries, illnesses, drug overdoses sexually transmitted diseases, substance abuse, and physical problems as adults" - also, higher rates of "premature death" - and also greater risk of earlier and riskier sexual behaviors - also huge risk of substance abuse "ACCOMPANYING DISORDERS AND SYMPTOMS" - ADHD ("more than 50% of children with CD also have ADHD")-- it should be noted that these are still two distinct disorders, but they just seem to overlap in some kids a lot - Depression --applies more to ODD than CD-- I.e. you see more kids with ODD and depression than with CD and depression. - Anxiety (can also be a protective factor) -- many girls with CD "develop a depressive or anxiety disorder in early adulthood" -- "for both sexes, increasing severity of antisocial behavior is associated with increasing severity of depression and anxiety"

DSM-5 Defining Features of Conduct Problems

"DSM-5 contains the general category of disruptive, impulse control, and conduct disorders. All disorders in this category involve problems in the self-control of emotions and behaviors, including two that refer to persistent pattern of antisocial behavior in youth-- oppositional defiant disorder (ODD) and conduct disorder (CD). This general category also includes intermittent explosive disorder (i.e., impulsive aggressive outbursts in response to minor provocations), pyromania (i.e., multiple episodes of deliberate and purposeful fire setting), and kleptomania (i.e., recurrent failure to resist impulses to steal items not needed for personal use or monetary value". ODD and CD are "collectively refereed to as conduct problems or disruptive behavior disorders" Oppositional Defiant Disorder (ODD) - "these children display an age-inappropriate recurrent pattern of stubborn, hostile, disobedient, and defiant behaviors." - DSM-5 definition: "a pattern of angry-irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least fur symptoms from any of the [listed later in this] categories, and exhibited during interaction with at least one individual who is not a sibling" - "ODD usually appears by age 8" -"Many of these behaviors, such as temper tantrums or arguing, are extremely common in young children. However, severe and age-inappropriate ODD behaviors can have extremely negative effects on parent-child interactions. Children with ODD are also at considerable risk for developing later impulse-control, substance-use, and mood and anxiety disorders, even after controlling for common co-occurring childhood disorders such as ADHD and CD." - "Child and adolescent ODD symptoms also predict a variety of social and interpersonal difficulties in early adulthood, including poor functioning with peers and poor romantic relationships." - ODD symptoms are grouped into categories: "--Angry/Irritable Mood --- Argumentative/Defiant Behavior --- "Vindictiveness" -Can be mild, moderate, or severe - "Some findings indicate that symptoms of ODD can be grouped into three dimensions that reflect negative affect (angry/irritable mood), defiance (defiant/headstrong behavior), and hurtful behavior (vindictiveness), which differentially predict later emotional and behavioral disorders in early adulthood." - "All three dimensions of ODD are highly correlated. However, symptoms of the hurtful behavior dimension do not seem to occur as consistently with symptoms of the other two dimensions, suggesting at they might be more related to the severe conduct problems of CD than to ODD" - Most kids referred for ODD show the behaviors in at least 2 settings. Conduct Disorder (CD) - DSM-5 Definition: "a repetitive and persistent pattern of behavior in which the basic rights of others or major age- appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at eat one criterion present in the past 6 months --Aggression to people and animals --Destruction of property -- Deceitfulness or theft -- Serious Violation of Rules Specify whether: -- Childhood-onset type -- Adolescent-onset type -- Unspecified onset Specify if: -- With limited prosocial emotions [which is determined by at least two of the following "characteristics" being present in the past 12 months and in multiple settings and relationships] --- lack of remorse or guilt --- callous-lack of empathy --- unconcerned about performance --- shallow or deficient affect" "several key features of CD: - Children with CD engage in severe antisocial behaviors.... - They often have co-occurring problems such as ADHD, academic deficiencies, and poor relation with peers - Their families often use child-rearing practices, such as harsh punishment, that contribute to the problem and often have their own problems and stresses, such as marital discord, psychiatric problems, and unemployment... - Their parents feel these children are out of control, and they feel helpless to do anything about it" ODD and CD have a lot of overlapping symptoms, but they are separate disorders.

Social Anxiety Disorder (Social Phobia) (SOC)

"a marked and persistent fear of social or performance requirements that expose them to scrutiny and possible embarrassment." Kids with this "may go to great lengths to avoid these situations, or they may face the challenge with great effort, wearing a mask of fearlessness" Makes social situations very very difficult for children. Can have somatic symptoms and even be panic-attack inducing. Common Seen more in girls than boys "generally develops after puberty, at a time when most teens experience heightened self-consciousness and worries about what others think of them"

Agoraphobia

"a marked fear or avoidance of certain situations in which the individual thinks that escape may be difficult, or help not available, if they were to experience panic-like or other incapacitating symptoms"

Anxiety

"a mood state characterized by strong negative emotion and bodily symptoms of tension in which the child apprehensively anticipates future danger or misfortune." "two key features of anxiety-- strong negative emotion and an element of fear" "future-oriented emotion characterized by feelings of apprehension and lack of control over upcoming events that might be threatening." "only anxiety [as opposed to fear also] is frequently felt when no danger is actually present"

Negative affectivity

"a persistent negative mood, as reflected in nervousness, sadness, anger, and guilt" linked with anxiety and depression

Panic Attack

"a sudden and overwhelming period of intense fear or discomfort that is accompanied by four or more physical and cognitive symptoms characteristic of the fight/flight response. Usually, a panic attack is short, with symptoms reaching maximal intensity in 10 minutes or less and then diminishing slowly over the next 30 minutes or the next few hours. Panic attacks are accompanied by an overwhelming sense of imminent danger or impending doom, and by an urge to escape. Although they are brief, they can occur several times a week or month." Easier to identify and track in adults than in children. Less common in you're kids, common in adolescents. "One explanation is that young children lack the cognitive ability to make the catastrophic misinterpretations (e.g., 'my heart is beating rapidly and I'm sitting here watching TV like I always do-- I must be going crazy') that usually accompany panic attacks. However, research suggests that young children may in fact be capable of such misinterpretations" Onset of panic disorder may also be linked with the onset of puberty-- something to do with hormones changing Untreated PD can be seriously debilitating, and lead to agoraphobia Adolescents with PD often have at least 1 comobrid disorder as well Average age of onset is 15-19 yo., and although young kids having it is rare, it can happen (see example of me).

Early Theories of Anxiety Disorders: Bowlby's Theory of Attachment

"according to attachment theory, fearfulness in children is biologically rooted in the emotional attachment needed for survival." "Children who view the environment as undependable, unavailable, hostile, or threatening may later develop anxiety and avoidance behavior"

Fear

"an immediate alarm reaction to current danger or life threatening emergencies" "present-oriented emotional reaction to current danger marked by a strong escape tendency and an all-out surge in the sympathetic nervous system." ALARM fear and anxiety are not the same thing!

OCD Related disorders: Body Dysmorphic Disorder

"characterized by a preoccupation with defects or flaws in physical appearance that are not observable or appear light to others. During the course of the disorder, the individual engages in repetitive behaviors (e.g., mirror checking, excessive grooming, seeking reassurance) or mental acts (comparing her or his appearance to others) in response to appearance concerns. This preoccupation causes significant distress or impairment in important areas of life functioning"

Panic

"is a group of physical symptoms of the fight/flight response that unexpectedly occur in the absence of any obvious threat or danger....the sensations themselves can feel threatening and may trigger further fear, apprehension, anxiety, and panic"

Physical Depndence

"occurs when the body adapts to the substance's constant presence, and tolerance refers to requiring more of the substance to experience an effect nice obtained at a lower dose. Another aspect of physical dependence is the experience of withdrawal, an adverse physiological symptom that occurs when consumption of nan abused substance is ended abruptly and is thus removed from the body"

Separation Anxiety Disorder (SAD)

"characterized by excessive worry regarding separation from home or parents. Youths may show signs of distress and physical symptoms on separation, experience unrealistic worries about harm to self or others when separated, and display an unwillingness to be alone" "age-inappropriate, excessive, and disabling distress related to separation from their parents or other major attachment figures and fear of being alone." Kids with this disorder may be anxious about something bad happening to themselves or to their parents if they are separated. Are afraid of new situations. Somatic symptoms can occur. One of the most common childhood anxiety disorders. Tends to be comorbid with other anxiety disorders or with depressive disorders. Also tend to be afraid of getting lost and of the dark. You also see school refusal or reluctance. Has the earliest age of onset and referral-- can be 7-8 yo. Often emerges following a major stressor in the child's life. Can continue into adulthood.

OCD related disorders: Hoarding Disorder

"characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value. This difficult is due to a perceived need to save the items and to distress associated with discarding them. The difficulty discarding possessions results in an accumulation of possessions that congest and clutter active living areas and substantially compromise their intended use. The hoarding causes significant distress or impairment in important areas of life functioning"

OCD realted disorders: Trichotillomania (hair-pulling disorder)

"characterized by recurrent pulling out of one's hair, resulting in hair loss (not attributable to another medical condition), repeated attempts to decrease or stop hair pulling, and significant distress or impairment in important areas of life functioning"

OCD related disorders: Excoriation disorder (skin-picking disorder)

"characterized by recurrent skin picking resulting in skin lesions, repeated attempts to stop skin picking, and significant distress or impairment in important areas of life functioning"

Selective Mutism

"children with [this disorder] fail to speak in specific social situations in which there is an expectation to speak (e.g., at school), even though they may speak loudly and frequently at home or in other settings. The DSM-5 criteria also require that the child's disturbance interferes with educational or work achievement or with social communication, that it is present for at least 1 month, that it is not limited to a lack of knowledge or discomfort with the spoken language required in the social situation, that it is not better explained by a communication disorder, and that it does not occur only during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder" Rare "the most common co-occurring disorders are other anxiety disorders, particularly SOC and specific phobia. Oppositional behaviors may also occur, but these may be limited to situations in which the child is required to speak" Makes things very difficult for the child New York Times article by Catherine Saint Louis: - talked about a treatment program in Florida for kids with selective mutism - the program is an "intensive, weeklong immersion" program, "in which selectively mute children are put through a variety of exercises to practice what frightens them most" - so this treatment is a kind of exposure therapy, I think - children are assigned "brave buddies," therapists working in the program who they would work on talking to at the beginning of the program and who would be their guide for the program. - the program varied in effectiveness from individual child to individual child - the kids treated in the program were all between 6 and 10 years old

Substance-use disorders (SUDS)

"during adolescence involve self-administration of any of these substances that alters mood, perception, or brain functioning, resulting in substance abuse or substance dependence." DSM-5 definition: - "the central diagnostic feature is straightforward: a problematic pattern of substance sue leading to significant impairment or distress. To meet this criterion, an adolescent (or adult) must show two or more clinical signs of distress for at least 12 months. The 11 possible signs of distress...reflect four groupings of symptoms that capture the core features of this diagnosis: impaired control,; social impairment; risky use; and pharmacological criteria. As with other disorders described in this textbook, these criteria do not adequately consider important developmental differences between adults and adolescents. Substance abusing adolescents experience withdrawal symptoms, but their physiological dependence and symptoms are less common than the withdrawal symptoms experienced by adults. Adolescents are more likely to show cognitive and affective features associated with substance abuse and/or withdrawal, such as disorientation or mood swings. SUDS among youths also differ from those of adults in terms of their pattern of use, which is likely a function of the restrictions on availability. For example, adolescents tend to drink less often, but drink larger amounts at any one time than adults drink (ie. binge drinking) which is associated with acute health and social risks. Adolescents' substance use also is strongly influenced by peers, their desire for autonomy and experimentation with adult 'privileges,' and the level of parental supervision they receive. These influences affect the expression and features of the SUDSin ways that differ from those of adults."

fight/flight response

"effects are aimed at escaping potential harm. either by confronting the source of danger (fight) or by evading it (flight)."

Generalized Anxiety Disorder (GAD)

"excessive and uncontrollable anxiety and worry about may events or activities on most days....worry when there is nothing obvious to provoke the worry. For children with GAD, worrying can be episodic or almost continuous. The worrier is unable to relax and may experience physical symptoms such as muscle tension, headaches, or nausea. Common symptoms of GAD include irritability, difficulty concentrating, and a lack of energy, difficulty falling asleep, and restless sleep" The name is pretty self explanatory Reassurance seeking "Children with GAD cannot seem to stop worrying even when they recognize how unhappy they are making themselves and others. This characteristic is what makes their anxiety abnormal. A normal child who is worried about an upcoming sports competition can still concentrate on other tasks and will stop worrying once the competition is over. However, for children with GAD one 'crisis' is followed by another in a never-ending cycle. The intensity of the child's worries is one of the best predictors of impairment in children with GAD. It may also lead to a sense that the worry is uncontrollable, which is an important clinical feature of GAD. The cognitive beliefs that children with GAD hold about worry may also play a role. Meta-worry, or worrying about worry, involves the development of beliefs such as worrying is uncontrollable or that it can lead to negative consequences for the worrier. For children with GAD, these negative beliefs about worry may lead to even higher levels of anxiety and more widespread anxiety." Uncommon Usually age of onset is early adolescence Tends to be persistent

Causes of SUDS

(*SUDS are highly comorbid with other disorders) Personality and Developmental Factors - circadian rhythm misalignment and sleep-wake rhythm changes and disruption. May lead be related to "the increased risk taking and sensation seeking during adolescence, which accelerates the transition from alcohol and drug experimentation to alcohol use disorders among teens" . Sensation seeking is especially related to marijauana use. - attitudes about substance use are also important, and the influence with peers also is super important Also feeling involved in school is a protective factor Family Background - "adolescents with a positive family history for alcoholism may inherit certain brain structures and functional abilities from one or both parents." - the effects of having parents with histories of substance abuse also effects the environmental and values factors that kids pick up. As well as what behaviors are modeled at home - the extent of parental monitoring are also important in terms of development of substance abuse disorders-- less parental monitoring is a risk factor - there may also be sex differences PEERS AND CULTURE ARE INSANELY IMPORTANT ALSO

Theories/Causes of Anxiety Disorders: "Family and Genetic Risk"

- "Children inherit general tendencies to be inhibited, tense, or fearful. In addition, both shared and non shared environmental influences have been shown to play a substantial role" -"anxiety disorders tend to be genetic and "run in families"

Conduct Problems (Prevalence)

- "ODD is more prevalent than CD during childhood, but by adolescence they occur equally often. Lifetime prevalence estimates are 12% for ODD (13% for males, and 11% for females), and 8% for CD (9% for males and 6% for females). The reason that overall lifetime prevalence rates are comparable is that ODD either declines or stays constant from early childhood to adolescence, whereas CD increases over the same time period. Prevalence estimates for CD and ODD are similar across cultures, although most comparisons to date have been made between Western countries rather than between Western and non-Western countries."

"Coping Cat: A Cognitive-Behavioral Treatment for Childhood Anxiety Disorders" by Shannon E. Hourigan et al.

- "The Coping Cat program is an individual-focused cognitive behavioral approach designed for youths with SAD, SP, and GAD." - In Australia it's called Coping Koala, and in Canada it's called Coping Bear :) - "The program involves two distinct portions: (1) psychoeducation/skills training and (2) exposure. In the first portion, the goals include forming a relationship with the client, providing psychoeducational information about anxiety, and teaching and rehearsing the use of a variety of anxiety management skills. In the second portion of treatment, the focus shifts from skill-building to skill utilization in anxiety-provoking situations; in other words, the emphasis is exposure tasks." - "not gender-specific and can be successfully implemented by both male and female therapists" - Sessions 1-8 of Coping Cat are for Psychoeducation and Skills Training -- therapist and child work together to build a "'tool set"' that the child can use "when faced with anxiety-provoking situations" -- "collaboratively, the therapist and child work on four main concepts, taught in order, allowing the child to build each new skill upon the previous one. First, the focus is on recognizing bodily reactions to anxiety. Next, the focus is on the child recognizing his own anxious self-talk and expectations about feared situations. Third, the child is introduced to and comes to understand how to cope in anxiety-provoking situations by using strategies such as coping thoughts and problem-solving. The last concept the child learns is rewarding himself for efforts made to approach and cope in feared situations. An acronym is used to help children remember these skills: the FEAR plan. FEAR is an acronym for Feeling Frightened? Expecting bad things to happen? Attitudes and Actions that can help, and Results and Rewards." -- children will often have homework called STIC (Show That I Can tasks) to do outside of sessions, and generally homework is assigned at the end of each session, and completed homework is looked at at the beginning of each session -- Usually, sessions will also end with short fun activities like board games or walks or the like. "This activity is included to support and bolster the client-therapist relationship." -- "another commonality across many sessions is a progression from modeling to role-playing, such that a child client learns each skill though multiple 'channels': didactically, via a workbook, through modeling, and then through direct rehearsal (i.e., role-play). Most skills are taught using this progression" -- psychoeducation includes learning about physiological/ somatic symptoms of anxiety -- the therapist and child will also construct a fear ladder using SUDS (subjective units of distress scale) ratings to rank the items on the fear ladder. This fear ladder can later be used to choose and direct exposures. -- after this, a child is taught relaxation techniques for fighting anxiety -- then they are taught to recognize anxious self-talk and cognitive restructuring-- "the child is then taught to (a) analyze the veracity of the thought (I.e., what is the evidence for the thought? How likely is the predicted outcome to occur?) and (b) identify thoughts that will promote coping and approach behaviors. As with all skills in Coping Cat, modeling and role-play are used extensively to teach and practice this difficult set of skills" -- Then the child is taught problem solving skills-- "here, the therapist introduces the idea that when confronted with anxiety provoking situations, there are things we can do and ways we can think to help ourselves feel less anxious and to do things that we are afraid to do....involves four steps: identifying the problem, brainstorm all possible solutions, evaluating the solutions, and selecting an option" -- finally, the for the self-evaluation and self-reward portion: "first, the client is taught to evaluate how well he coped with the situation. That is, the focus is on the process of coping and not on the outcome of the situation. Many times, a great outcome is not possible, though we can cope well in many of those situations. Second, the client is taught to reward himself for coping effort (and not the production of a positive outcome). The use of coping modeling, role-plays, and other modalities are useful for this skill." -- last is The Coping Plan: "after working on the R step, the client is then reintroduced to the entire FEAR pan and time is spent modeling and rehearsing the use of the plan as a four-step coping method. The focus here is preparation for the exposure tasks coming next." -Part 2 of Coping Cat: EXPOSURE (duh duh duh!) -- use of both in vivo (real life) and imaginary exposures-- because some exposures can't actually be done in real life over and over again -- work your way up the fear ladder by doing exposure tasks with increasingly high levels of SUDS attached to them over time, starting with the least anxiety provoking ones and working up -- take SUDS rating throughout exposure tasks "so that you and the client can see if the exposures are producing the desired habituation to the stimuli" -- all the exposures should be done more than once. "These repetitions are called trials and are an important way to increase the effectiveness of exposures. If the client practices the same exposure task multiple times, anxiety reduction tends to occur more rapidly with each successive task. The repetition is used to demonstrate that 'the more we do it, the easier it gets'" -- client and therapist discuss how the exposure went after each exposure, and "the therapist praises the child and rewards him for his effort regardless of whether the outcome is perceived to be a total success" -- caregiver involvement also comes in at this stage (and earlier also), although the focus is going to be primarily on working with the kid one on one. However, it is always good, and necessary, to get parents involved in and informed of skills being taught and exposure tasks. - At the end of treatment, the child will complete a "final 'graduation' exposure task" and make a "'commercial"' where the kid explains what they have learned in treatment. This is hopefully fun of the kid and consolidates everything the kid has learned

Prevention of SUDS

- "because adolescence is a time of rapid, major transitions and changes in physical, emotional, and social domains, prevention efforts related to substance abuse increasingly are being introduced at the elementary and secondary school levels. Facilitating successful transitions-- for example, in the areas of romantic and peer relationships, sexual behavior, and healthy lifestyle choices-- has the added major benefit of reducing multiple problematic outcomes in later life. Critical health-damaging behaviors that are preventable include substance use and abuse, unsafe sexual practices, and abusive behaviors, which all have a common context of peer and dating relationships. These prevention efforts are being as having important payoffs in terms of reductions in future health problems and enhancement of personal goals." - "Effective approaches to adolescent substance abuse prevention have addressed multiple influences on the individual from peers, family, school, and community. life Skills Training, a detailed and well-evaluated program, emphasizes building drug-resistance skills, personal and social competence, and altering cognitive expectancies around substance use. Because adolescents must receive consistent messages and reinforcement regarding pressures to use alcohol and drugs, as well as develop effective refusal skills, societal messages about responsible use are emphasized to influence students' behavior. Prevention programs also target the social environment through community and school norms and their efficacy to enact change and they often include some level of parent involvement and education to us improve parent-child communication about substance use" - SEE ARTICLE(S)

Callous and unemotional (CU) interpersonal style

- "characterized by an absence of guilt, lack of empathy, uncaring attitudes, shallow or deficient emotional responses, and related traits of narcissism and impulsivity" - found in some (but not all!) kids with CD - "Children with CU traits display a greater number and variety of conduct problems, and they have more frequent contact with police and a stronger parental history of APD than other children with conduct problems. Research with children and adolescents has found that CU interpersonal and affective traits predict persistent delinquency, future recidivism, and symptoms of APD in early adulthood." - there can be a range of how much CU traits are present, and in some these traits will change over time in some direction. In others, these traits will hold stable.

Article: "The Prevention of Detention" by David A. Brent, M.D., and Rolf Lobber, Ph.D.

- "early onset conduct problems are multi determined and influenced by neighborhood, peer and classroom ecology, poverty, parenting practices, social-cognitive and academic skills, and temperament" - "The goal of Fast Track was to attenuate the trajectory of disruptive behavior and associated sequelae" - "In light of the multi determined pathways to delinquency, the Fast Track Program chose to test a set of high intensity multimodal interventions that simultaneously addressed multiple risk and protective factors to prevent conduct problems and related sequelae" - The Fast Track Program included: -- Kids in kindergarten "who were assessed by their teachers and parents to have conduct problems were randomly assigned by classroom to either Fast Track or usual care" -- grades 1-5, kids in Fast track and their families receive: -- social skills groups -- parent training groups -- "additional in and out of classroom educational and social support to promote academic and social confidence" -- home visits -- middle school and high school: "groups of youths were offered instruction on adolescent development, drug and alcohol use, and life and vocational goals. Families also received individualized interventions that targeted multiple domains" - "youths assigned to Fast Track, compared with control subjects, were less likely to have any externalizing, internalizing, or substance use disorder (59% compared with 69%). Youths involved in Fast Track had lower rates of antisocial personality disorder, alcohol and substance abuse, and risky sexual behavior, as well as lower rates of violent crime and substance abuse convictions." They were also better parents. Property crime statistics weren't improved much, but you can't win them all and this is pretty freaking impressive regardless. - One issue with Fast Track is that it is very expensive -- "Fast Track was cost-effective only for those participants in the top 10th percentile for conduct problems"-- because it was so expensive. - Other programs that try to deal with similar issues are the Nurse Family Partnership and the Good Behavior Game - Multisystemic therapy also can be effective

Substance Abuse and Addictive Disorders

- "in DSM-5 encompasses 10 separate classes of drugs, including alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, tobacco, and other (or unknown) substances. Gambling has been added in DSM-5 as an addictive disorder."

Theories/Causes of Anxiety Disorders: Family Factors

- "parenting practices such as rejection, over control, overprotection, and modeling of anxious behaviors have all been identified as contributors to childhood anxiety symptoms and disorders" - if parents don't grant enough autonomy to their kids, it can also be linked to anxiety disorders. - same goes for "emotional over involvement" - family dysfunction may also be kinked to anxiety disorders - SEE ARTICLES - SEE FIGURE 11.3 ON PAGE 390

"Antisocial Personality Disorder (APD) and Psychopathic Features"

- "persistent aggressive behavior in childhood may be a precursor of adult antisocial personality disorder (APD), a pervasive pattern of disregard for, and violation of, the rights of others, including repeated illegal behaviors, deceitfulness, failure to plan ahead, repeated physical fights or assaults, rickets disregard for the safety of self or others, repeated failure to sustain work behavior or honor financial obligations, and a lack of remorse" - "Research has found that as many as 40% of children with CD develop APD as young adults." - "In addition to their early CD, adolescents with APD may also display psychopathic features, which are defined as a pattern of callous, manipulative, deceitful, and remorseless behavior" - "youths who display psychopathic features appear to be aware that their aggressive behavior will cause others to suffer-- but they don't care. Rather, their goals in conflict situations involve revenge, dominance, and forced respect." - you can start to see "signs of a lack of conscience" as early as 3-5 yo in some kids. - "adolescents with CD are less likely than peers to show affective empathy or embarrassment, which suggests a failure to inhibit emotions and actions in accordance with social conventions"

Treatment of Conduct Problems

- "restrictive approaches such as residential treatment, inpatient psychiatric hospitalization, and incarceration," as well as "psychotherapy, group therapy, tutoring, punishment, wilderness programs, and boot camps" are all not that effective. - intervention (and prevention) has to be early and ongoing in order to even stand a chance of being effective - parent management training(PMT): "teaches parents to change their child's behavior in the home and in other settings using contingency management techniques. The focus is on improving parent-child interactions and enhancing other parenting skills (e.g., parent-child communication, monitoring, and supervision)" - problem-solving skills training (PSST): "identifies the child's cognitive deficiencies and distortions in social situations and provides instruction, practice, and feedback to teach new ways of handling social situations. The child learns to appraise the situation, change his or her attributions about other children's motivations, be more sensitive to how other children feel, and generate alternative and more appropriate solutions." Is a type of CBT. - multi systemic therapy (MST): "an intensive approach that draws on other techniques such as PMT, PSST, and marital therapy, as well as specialized interventions such as special education, and referral to substance abuse treatment programs or legal services"

Article: "Males on the life-course-persistent and adolescence-limited antisocial pathways: follow-up at age 26 years" by Terrie E. Moffitt et al.

- LCPs are those "whose antisocial behavior begins in childhood and continues worsening thereafter" - AL "antisocial behavior beings in adolescence and desists in young adulthood" - LCPs show greater exposure to environmental risk factors a lot of the time - snares are things that can make an AL not stop being an AL when they age, like drug addiction or a conviction - article also discussed recovery group, which turned out to still have a lot of problems even though they appeared at first glance to be "recoveries" and abstainer group, which Moffitt describes as a group that does not have nay antisocial behaviors, they are really unusual, and tend to be well-adjusted adults but inhibited, awkward teenagers- Moffitt suggests that as tens these individuals actually have some characteristic that makes them isolated. - LCPS tended to commit more frequent and serious crimes, whereas ALs tended towards more minor crimes like property crimes and drug offenses - LCPS also had worst psychopathology and mental heath issues, although AL men also had high scores of these - LCP men had the worst relationship scores - LCP men had the worst economic issues - the maturity gap may explain why some ALs struggle so much to leave antisocial behavior behidn as they age

Treatment for Anxiety Disorders and OCD

- SEE ARTICLES SUDS: SUBJECTIVE UNITS OF DISTRESS - Behavior Therapy -- exposure ("having children face what frightens them, while providing ways of coping other than escape and avoidance" ) --graded exposure (a gradual process of exposure that goes on a hierarchy of exposure tasks created by the child and therapist together) -- systematic desensitization ("consists of three steps: (1) teaching the child to relax; (2) constructing an anxiety hierarchy; and (3) presenting the anxiety-revoking stimuli sequentially while the child remains relaxed. With repeated presentation, the child feels relaxed in the presence of stimuli that previously provoked anxiety" ) -- flooding (exposure is carried out in prolonged and repeated doses (massed exposure). Throughout the process, the child remains in the anxiety provoking situation and provide anxiety ratings until the levels diminish. Flooding is typically sed in combination with response prevention, which prevents the child from engaging in escape or avoidance behaviors. More than other approaches, flooding may create distress, especially during the early stages of treatment. This procedure must be used carefully, especially with young children who may not understand the rationale") -- "one of the most effective procedures for treating specific phobias involves participant modeling and reinforced practice. Using this procedure, the therapist models the desired behavior (e.g., approaching the feared object), encourages and guides the child in practicing this behavior and reinforces the child's efforts. Although all exposure procedures are effective, real life, or in vivo exposure, works best-- but it is not always easy to implement. Once the child faces her fear in a real-life situation with no adverse consequences, she is more confident about doing it again." -- Other useful behavior therapies are directed at reducing the physical symptoms of anxiety. these include muscle relaxation and special breathing exercises. Children who are anxious often take rapid shallow breaths (hyperventilation_) that can produce increased heart beat, dizziness, and other symptoms. Relaxation procedures are often used with gradual exposure." - CBT (Cognitive behavioral therapy) -- "the most effective procedure for treating most anxiety disorders in young people" -- "in addition to using behavior therapy procedures, CBT teaches children to understand how thinking contributes to anxiety ad how to modify their maladaptive thoughts to decrease their symptoms" -- "Making the youngster aware of thought patterns and ways to change them complements exposure and other behavioral therapy procedures, such as positive reinforcement and relaxation. CBT and exposure-based treatments are almost always used in combination" -- Coping Cat -- SEE ARRiCLE (S) - Family Interventions --"Greater parental involvement in modeling and reinforcing coping techniques, inclusion of parent skills training may be especially important in treating younger children with anxiety" -- addressing children's anxiety disorders in a family context may result in more dramatic and lasting effects than focusing only on the child, particularly for children of anxious parents". This is especially important for OCD, especially childhood OCD. - Medications -- selective serotonin reuptake inhibitors (SSRIS) - especially effective with OCD.

OCD and anxiety disorders: Associated Characteristics: Cognitive Disturbances

- anxiety and OCD can really impact school performance - "children at risk for anxiety and those with anxiety disorders selectively attend to information that may be potentially threatening or dangerous( e.g., an angry looking face)- a tendency referred to as anxious vigilance or hyper vigilance. The more severe the children's anxiety, the stronger is their attention to potentially threatening stimuli. Anxious vigilance permits the child to avoid potentially threatening events by early detection, with minimal anxiety and effort. Although this may benefit the child in the short term, it has the unfortunate long-term effect of maintaining and heightening anxiety by interfering with the information processing and coping responses needed to learn that many potentially threatening events are not so dangerous after all." - kids with naivety disorders often have cognitive distortions and go out of their way to avoid things they think are threatening - "children with anxiety disorders employ ore maladaptive and less adaptive cognitive coping strategies and responses to stressful life events than non anxious children. Their cognitive coping strategies rely more on catastrophizing (e.g., thinking that something is far worse than it actually is) and rumination and less on positive reappraisal and planning" - physical symptoms are present in a lot of anxiety disorders as well (and with OCD) - kids with anxiety disorders often have difficulty with social stuff and with emotional expression and regulation - depression often co-occurs with anxiety-- linked to concept of negative affectivity

Theories/Causes of Anxiety Disorders: Neurobiological Factors

- brain differences are related to anxiety

Article: "New Insights on College Drinking" by Anna Miller. Was from the American Psychological Association.

- drinking related deaths and injuries are a huge problem on college campuses - there are new prevention efforts that rely on trying to figure out who is most at risk for problem drinking and targeting them for prevention. We think that these people are "incoming freshmen, student athletes, and those involved in the Greek system" - "personality factors, such as impulsivity and sensation-seeking, also contribute to risky drinking" - women also tend to become problem drinkers much faster than men, but "men drink more on average than women" - subjective intoxication is "another factor that appears to distinguish between students who drink a lot yet remain relatively safe and those who drink the same amount or less yet suffer the consequences. Subjective intoxication is "a student's likelihood to get into trouble during or after drinker has as much to do with how drunk he or she feels as it does with how much he or she actually drinks" - students who drink to deal with emotional issues are at the most risk. - campus wide campaigns tend not to be that effective. The BASICS program at the University of Washington was a new kind of intervention that has now been adapted by many schools. In the program, when a student comes into the mental health care or regular health care office, "or are referred for an alcohol-related offense", the program "gives students personalized feedback on their drinking behaviors, including comparing how much they drink with how much the average student on their campus drinks. The intervention also uses motivational interviewing by asking students open-ended nonjudgmental questions to explore drinking behaviors and generate motivation to change. Finally, it offers individualized strategies- such as putting ice in drinks or assigning a designated driver- to help students drink in less risky ways. The method, which has been shown to reduce how much students drink as well as to reduce related negative consequences up to four years out, meets NIAAA's highest standards for evidence-based college drinking interventions" - but this program is only effective for some students. Students with a lot of social anxiety might not be as influenced by the program, for example. - scientists have worked on experimenting with different versions of this intervention and have found that shorter versions and student led versions can be effective too. - in order for programs to be effective, they must address things that are important to individual students or types of students (example given in article was telling student athletes "how alcohol affects hydration and athletic performance") - The STEPS Comprehensive Alcohol Screening and Brief Intervention Program at the University of Albany's Counseling Center is modeled on BASICS - use of behavioral economics in designing some programs. Behavioral economics is "the idea that behavior is influenced by availability and cost" - some interventions also "target certain events, rather than people"-- like 21st birthday parties. - time interventions are also being used-- in these interventions are spaced over time leading up to some big drinking event

Treatment of SUDS

- family-based approaches "seek to modify negative interactions between family members, improve communication between members, and develop effective problem-solving skills to address areas of conflict." - "multi systemic therapy (MST)...involves intensive intervention that targets family, peer, school, and community systems; it has been especially effective in the treatment of SUDS among delinquent adolescents. Parents or other care providers are provided with step-by-step guidelines for implementing contingency management to control adolescent substance abuse. These steps include familiar cognitive-behavioral interventions such as behavioral contacts and contingencies to reinforce abstinence, as well as was to overcome common roadblocks to treatment" - motivational interviewing - "uses a patient-centered and directive approach that addresses the ambivalence and discrepancies between a person's current values and behaviors and their future goals. In general, the type of treatment indicated depends on the levels of use and the individual's home environment. Adolescents with low to moderate levels of substance abuse and a more stable home environment are reasonable candidates for outpatient treatment, whereas those with more severe levels of substance abuse, an unstable living situation, or comorbid pscyochopathology may require an inpatient or residential setting"

Prevention of Anxiety Disorders

- it seems early interventions might be effective - the general theme appears to be that more research is required

Causes of Conduct Problems

- no one cause Genetics - "50% or more of the variance in antisocial behavior is attributable to heredity for both males and females. This influence is somewhat higher for aggressive versus nonaggressive conduct problems in childhood versus adolescence. Research indicates that parents pass on a general liability for externalizing disorders to their children that may be expressed in different ways, inclining oppositional and conduct problems, inattention, and hyperactivity-impulsivity. The heritability of conduct problems also varies by age at onset and other factors" -- "the strength of the genetic contribution is higher for children who display the LCP versus the AL pattern and for those with callous-unemotional traits" - there are probably multiply pathways that genetic factors work on, including temperament, sensitivity, etc... Then also environmental risk factors may interact with genetic factors to do stuff "Prenatal factors and birth complications" - low birth weight - "malnutrition during pregnancy is associated with later antisocial behavior, which may be mediated by protein deficiency" - lead exposure/poisoning - maternal nicotine, marijuana, etc... use during pregnancy. also alcohol. - but these are not as strong of factors as environment and genetics, etc.... Neurobiological - behavioral activation system (BAS) -- "stimulates behavior in response to signals of reward or non punishment" -behavioral inhibition system (BIS) -- "produces anxiety and inhibits ongoing behavior in the presence of novel events, innate fear stimuli, and signals of non reward or punishment" - "it has been proposed that antisocial patterns of behavior result form an overactive BAS and an underachieve BIS-- a pattern determined primarily by genetic predisposition." - "individual differences in antisocial behavior have been related to variations in stress-regulating mechanisms, including the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic onerous system (ANS), serotonergic functioning, and structural and functional deficiencies in the prefrontal cortex of the brain" "Social-Cognitive Factors" - social-cognitive abilities: "refer to the skills involved in attending to, interpreting, and responding to social cues. There is a strong relationship between social-cognitive deficits and antisocial behavior across all types of conduct-problem trajectories (e.g., childhood limited, adolescent onset, early-onset persistent), especially for children showing early-onset persistent conduct problems" - "steps in the thinking and behavior of egressive children in social situations --encoding: socially aggressive children use fewer cues before making a decision. When defining and resolving an interpersonal situation, they seek less information about the event before acting. -- interpretation: socially aggressive children attribute hostile intentions to ambiguous events. -- response search: socially aggressive children generate fewer and more aggressive responses and have less knowledge about social problem solving. -- response decision: socially aggressive children are more likely to choose aggressive solutions. -- enactment: socially aggressive children use poor verbal communication and strike out physically" Family Factors - "early maternal age at childbearing, poor disciplinary practices, harsh discipline, a lack of parental supervision, a lack of affection, martial conflict, family isolation, and violence in the home" - "positive parenting practices" can be protective factors for at-risk children - especially potent risk factors for LCPs - reciprocal influence: "the child's behavior is both influenced by and influences the behavior of others." - coercion theory: "parent-child interactions provide a training ground for the development of antisocial behavior." Basically, both sides back off in some way to avoid aggressive and/or unpleasant interactions-- parent will not try to parent, and child will be more under the radar with their behavior and also will learn that by making things unpleasant they can avoid consequences for their actions. - attachment issues may be involved as well - other family facts, such as how stable the family is, whether the parents are mentally ill or have been in jail, etc... are also factors that come in here - amplifier hypothesis: "states that stress amplifies the maladaptive predispositions of parents (e.g., poor mental health), thereby disrupting family management practices and compromising parents' ability to be supportive of their children" - "aggressive and antisocial tendencies run in families, within and across generations" - parents of antisocial children tend to get into trouble with the law themselves "Societal Factors" - POVERTY - NEIGHBORHOOD CRIME - SOCIOECONOMIC STATUS - School - "antisocial behavior in youths is disproportionately concentrated in poor neighborhoods characterized by a criminal subculture that supports drug dealing and prostitution, peer group violence, delinquent gang membership, frequent transitions and mobility, and low social support from neighborhood or religious groups." - Social selection hypothesis: "states that people who move into different neighborhoods differ from one another before they arrive, and those who remain differ from those who leave. For individuals with antisocial traits, this creates a community organization that minimizes productive social relations and effective social norms, leading to the antisocial behavior becoming the rule." Because "antisocial people tend to select neighborhoods populated by other people who are like them." - also, lower quality schools tend to be in bad neighborhoods. "A positive school experience can be a protective factor". - Media may also have an influence, although there is a big debate about how big that influence might be. It also seems to depend on the individual child. And it probably reinforces antisocial stuff, but probably doesn't straight up cause it. "Cultural Factors" - different cultures may place different values on aggressive behavior, and that can affect behavior and development of disorders

Prevention of Conduct Problems

- start early - address risk factors and make protective factors stronger - it may cost more in the moment, but it will save society money in the long run - fast track! SEE ARTICLES

Article: "Impact of Early Intervention on Psychopathology, Crime, and Well-Being at Age 25" by Kenneth A. Dodge et al.

- this study looked at kids who had participated in the Fast Track program when the kids were 25, 8 years after the program ended - the researchers examined "eight domains that index adult functioning: externalizing psychopathology, internalizing psychopathology, substance abuse, criminal conviction, risky sexual behavior, aggression toward partners and offspring, education/employment, and general well-being." - the study found that: -- "children assigned to intervention were significantly less likely than children in the control group to exhibit any externalizing, internalizing, or substance use problem" -- "assignment to intervention significantly decreased the expected severity-weighted violent crime conviction index by 31% and drug conviction index by 35%....intervention did not affect property/public order crime." -- "assignment to intervention increased the overall well-being and happiness scores but had no significant effect on general health index and personal strength scores" -- "assignment to intervention did not affect the probability of graduating from high school or of being employed full time or of higher education at age 25" - "assignment to intervention decreased the lifetime number of sexual partners... and risky sexual behavior in the past 12 months... Among participants who maintained a romantic relationship in the past year, the intervention effect on violent acts against romantic partners was not significant" - "assignment to intervention significantly decreased spanking of participants' offspring...The effect was significantly moderated by gender, with a stronger effect among male participants than female participants. Intervention had no effect on coercive parenting, marginally increased parenting efficacy..., and had no effect on parenting satisfaction" - "the findings are consistent with a developmental cascade model in which changes in skills and social experiences early in life cascade into changes in broader outcomes many years later"

Conduct Problems (Gender)

-"antisocial behaviors are more common in boys than in girls during childhood, but this difference narrows in adolescence" - "clear gender differences in the frequency and severity of antisocial behavior are evident by 2 to 3 years of age. During childhood, rates of conduct problems are about 2 to 4 times higher for boys than for girls, with boys showing an earlier age at onset and greater persistence. Boys also display more conduct problems and report using more physical aggression than girls across countries throughout the world. This gender difference does not imply that girls do not display severe conduct problems, including physically aggressive behavior, they just do so much less often than boys" - "the gender disparity in conduct problems increases through middle childhood, narrows greatly in early adolescence--due mainly to a rise in covert nonaggressive antisocial behavior in girls- and then increases again in late adolescence when boys are at the park of their delinquent behavior" - "antisocial girls are more likely than others to develop relationships with antisocial boys, then become pregnant at an earlier age and display a wide spectrum of later problems, including anxiety, depression, and poor parenting" - "boys remain more violence prone than girls throughout their life span, and are more likely to engage in repeated acts of physical violence" - "in addition, physical aggression by girls during childhood, when it does occur, does not seem to forecast continued physical violence and other forms of delinquency in adolescence, as it does for boys" - girls can still be violent though, make no mistake - "the sex difference in antisocial behavior has decreased by more than 50% over the past 60 years, suggesting that females may be more susceptible to or more affected by contemporary risk factors, such as family discord or media influences and/or that there is a growing recognition of these problems in girls" - "conduct problems are one of the most common mental disorders in adolescent girls" - girls tend towards using relational aggression, which tends to be indirect and take the form of things like gossiping, telling on others, austere sizing others, etc.... than being physical. "In addition, girls are more likely than boys to become emotionally upset by aggressive social exchanges." "As girls move into adolescence, the function of their aggressive behavior increasingly revolves around group acceptance and affiliation, whereas for boys, aggression remains confrontational." - earlier physical maturity may also play a role as regards conduct problems in girls

Theories/Causes of Anxiety Disorders: Temperament

-"inherited differences in the neurochemistry of brain structures thought to play an important role in detecting discrepant events" are partly responsible for this - behavioral inhibition (BI): "an enduring trait for some and a predisposing factor for the development of later anxiety disorders, particularly SOC." "a low threshold for becoming overexcited and to withdrawing in response to novel stimulation as infants, a tendency to be fearful and anxious as toddlers, and a tendency to be unusually shy or withdrawn in novel or unfamiliar situations as young children." - SEE ARTICLE(S)

Conduct Problems (Course)

Age of onset: - Childhood onset vs adolescent onset matters-- childhood onset tends to be worse - a difficult temperament in very very early childhood and infancy can be an early indicator of conduct problems to come (although this temperament may not always signal that its conduct problems specifically, but it can) - "during the preschool and early school years, a child with a difficult temperament displays an increase in hyperactivity and impulsivity with growing mobility, weak emotion-regulation skills, and a heightened risk for simple forms of oppositional and aggressive behaviors that peak during the preschool years. Preschoolers with ODD display stubbornness, temper tantrums, irritability, and spitefulness- problems that remain stable from 2 to 5 yeas of age. Discipline problems and poor self control and emotion regulation during early childhood, especially when accompanied by harsh parenting and high level so stress, are strong indicator that he child will continue to experience behavior problems and negative outcomes across nearly every area of life functioning in adolescence and adulthood." -"Most children with conduct problems show diversification-- they add new forms of antisocial behavior over time rather than simply replacing old behaviors. Poor social skills and social-cognitive deficits often accompany early oppositional and aggressive behaves, predisposing the child to poor peer relationships, rejection by peers, and social isolation and withdrawal. When the child enters school, impulsivity and attention problems may result in reading difficulties and academic failure. Covert conduct problems, such as truancy or substance use, also begin to appear during the elementary school years, and increase into early adolescence. From ages 8 to 12, behaviors such as fighting, bullying, fire setting, vandalism, cruelty to animals and people, and stealing begin to emerge." -- is "a snowballing negative cycle over time, where one deficit or problem behavior produces direct and indirect change in others" - "major conduct problems become more frequent during adolescence" - Moffitt and the LCP (life-course persistent) vs. AL (adolescence limited) paths -- LCPs start as children, whereas ALs start as adolescents. ADD MORE TO THIS FOR ACTUAL ARTICLE -- snares -- adult outcomes are worst for LCPs

Conduct Problems (Costs)

Conduct problems are "the most costly mental health problem in North America" this is pretty insane, considering that conduct disorders only affect about 5% of kids. "These children cause considerable and disproportionate amounts of harm, accounting for over 50% of all crime in the United States, and about 30% to 50% of clinic referrals" Access to firearms compounds the problem. "As much as 20% of all mental health expenditures in the United States are attributable to crime. The additional public costs per child with conduct problems across the health care, juvenile justice, and educational systems are enormous-- at least $10,000 or more a year. The lifetime costs to society for one youth to leave high school for a life of crime and substance abuse have been estimated to be about $3.2 million to $5.5 million"

Conduct Problems (Context)

Kids with conduct problems "frequently (not always) grow up in extremely unfortunate family and neighborhood circumstances, where they experience physical abuse, neglect, poverty, or exposure to criminal activity. Thus, in many cases, aggressive behaviors are an adaptation to home and neighborhood violence and neglect." a certain level of antisocial behavior is normal at different levels at different developmental stages-- toddlers often exhibit antisocial behaviors which they usually grow out of, and then teenagers often exhibit different forms of antisocial behaviors-- this is developmentally normal. In fact, it is abnormal to not show any antisocial behaviors during adolescence. On the other hand, to not grow out of these behaviors or have them at an exaggerated or abnormal level is also really not good. Kids who are really really aggressive early on tend to stay aggressive as they age.

Conduct Problems (Perspectives)

Legal Perspective: - Juvenile Delinquency: "describes children who have broken a law." Laws vary across states, etc... "Delinquency, the legal definition, involves apprehension and court contact and excludes the antisocial behaviors of very young children that usually occur at home or school. It is also important to distinguish official records of delinquency from self-reported delinquency" "only a subgroup of youths who meet a legal definition of delinquency will also meet the definition for a mental disorder" Psychological Perspective: -"conduct problems fall along a continuous dimension of externalizing behaviors. Children at the upper extreme of this dimension, usually one or more standard deviations above the man, are considered to have conduct problems. The externalizing dimension itself consists of two related but independent sub dimensions, labeled 'rule-breaking behavior' and 'aggressive behavior'. Rule-breaking behaviors include running away, setting fires, stealing, skipping school, using alcohol and drugs, and committing acts of vandalism. Aggressive behaviors include fighting, destructiveness, disobedience, showing off, being defiant, threatening others, and being disruptive at school." - "Two additional independent dimensions of antisocial behavior have been identified: overt-covert and destructive-nondestructive. The overt-covert dimension ranges from overt visible acts such as fighting to covert hidden acts such as lying or stealing. Children who display overt antisocial behavior tend to be negative, irritable, and resentful in their reactions to hostile situations and to experience higher levels of family conflict. In contrast, those displaying covert antisocial behavior are less social, more anxious and more suspicious of others and come from homes that provide little family support. Most children with conduct problems display both overt and covert behaviors. These children are in frequent conflict with authority, show the most severe family dysfunction, and have the poorest long-term outcomes. The destructive-nondestructive dimension ranges from acts such as cruelty to animals or physical assault to nondestructive behaviors, such as arguing or irritability." - "Children who display overt-destructive behaviors, particularly persistent physical fighting, are at especially high risk for later psychiatric problems and impairment in functioning" Psychiatric Perspective: - "conduct problems are defined as distinct mental disorders based on DSM-5 symptoms." "Note: Both categorical (psychiatric) and dimensional (psychological) perspectives have proven validity for classifying conduct problems in youth. Categories such as CD or ODD are associated with different patterns of behaviors and outcomes. On the other hand, dimensional measures of externalizing behavior in adolescence may be better predictors of adult outcomes than categorical measures. In other words, each perspective provides useful information." Public Health Perspective: - "this perspective blends the legal, psychological, and psychiatric perspectives with public health concepts of prevention and intervention" - "The goal is to reduce the number of injuries and deaths, personal suffering, and economic costs associated with youth violence, in the same way that other health concerns such as automobile accidents or tobacco use are addressed. The public health approach cuts across disciplines and brings together policy makers, scientists, professionals, communities, families, and individuals to understand conduct problems in youths and determine how they can be treated and prevented."

Obsessive Compulsive Disorder (OCD) and related disorders

Not listed as an anxiety disorder in the DSM anymore-- has its own category now, although it is related to anxiety disorders. Related disorders include: Body Dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder. "recurrent, time consuming (taking more than 1 hour a day), and disturbing obsessions and compulsions. Obsessions are persistent and intrusive thoughts, urges, or images that are experienced as intrusive and unwanted, and generally use significant anxiety or distress" "compulsions are repetitive, purposeful, and intentional behaviors (e.g., hand washing) or mental acts (e.g., repeating words silently) that are performed in response to obsessions in an attempt to suppress or neutralize them." Kids with OCD usually have multiple obsessions and compulsions. There is some evidence that "the neural mechanisms of OCD symptoms in children versus adults" are different. More common in boys than girls when it occurs in younger children, but is about the same between genders in adolescents. Comorbid disorders are common. Mean age of onset is 9-12 yo, there are two peaks: early childhood and late adolescence/early adulthood. Younger age of onset typically indicates a "poorer outcome"

Specific Phobia

age-inappropriate, persistent, irrational, "exaggerated, leads to avoidance of the object or event, and causes impairment in normal routines" fear of something. The thing feared is typically a nonthreatening and non dangerous one. Is the other most common childhood anxiety disorder (along with SAD)

Prevalence and Course of SUDS

alcohol is the most commonly used substance and the most commonly abused substance for adolescents. Cigarettes are going down in popularity and use There are "relatively high levels of substance use among adolescents and "a significant portion meet criteria for a diagnosis of substance abuse or substance dependence". "Much higher rates of these disorders (about one in three) are reported among youths with histories of other mental health problems, or with involvement in the child welfare or juvenile justice systems". Age of onset is extremely important in terms of whether or not someone develops a substance abuse disorder or dependence. The younger the age of onset, the higher the risk. - "typically, rates of substance use peak around late adolescence, and then begin to decline during young adulthood, in conjunction with adult roles of work, marriage, and parenthood. However, for some youths, a pronounced pattern of early-onset risk taking may signal a more troublesome course that can threaten their well-being in both the short term and long term....Although experimentation with substances is commonplace among teenagers, it is not harmless; substance use lowers inhibitions, reduces judgement, and increases the risk of physical harm and sexual assault." - "most adolescent risk and problem behaviors co-occur, so an indication of one problem is often a signal that others may be happening or on their way"

Conduct Problems (Description)

also called antisocial behaviors "terms used to describe a wide range of age-inappropriate actions and attitudes of a child that violate family expectations, societal norms, and the personal or property rights of others. These children experience problems in controlling their emotions and behavior." "youths with conduct problems display a variety of disruptive and rule-violating behaviors, ranging from annoying but relatively minor behaviors such as whining, swearing, and temper tantrums to more serious forms of antisocial behavior such as vandalism, theft, and assault"

Anxiety-- cognitive system

anxiety can make it very very hard to focus and have other cognitive effects as well. Kids with anxiety "will invent explanations for their anxiety", or will focus only on trying to figure out why they are so anxious instead of doing other stuff they need to be doing or thinking about. "Activation of the cognitive system, often leads to subjective feelings of apprehension, nervousness, difficulty concentrating, and panic"

Neurotic paradox

is when "even if the child knows there is little to be afraid of, he or she is still terrified and does everything possible to escape or avoid the situation" "pattern of self-defeating behavior"