Exam 2 (Chapters 15 and 16)
Pediatric psychologies activities fall into three categories:
1) Inpatient consultation liaison- The 5 C's of consultation: Crisis, Coping, Compliance, Communication, Collaboration. 2). Chronic conditions 3) Specialized care
Overlearning
A component of full spectrum home training; after remaining dry at night for 24 consecutive nights, a child continues to drink large amounts of fluids and delay voiding to prevent the return of nocturnal enuresis.
Retention Control Training
A component of full spectrum home training; children with enuresis drink increasing larger amounts of fluids and delay voiding for longer periods of time to become sensitive to a full bladder and to increase functional bladder capacity.
Facial Screening
A form of positive punishment sometimes used to treat pica; the mouth is temporarily screened with a bib or loose-fitting mask to avoid substance ingestion; used only with caregiver assent when other interventions have failed and ingestion is potentially harmful.
What is Diabetic Ketoacidiosis?
Occurs when blood glucose levels are unusually high. Usually happens when having large or sugary meal with not enough insulin to metabolize.
What is Hypoglycemia?
Occurs when children allow blood glucose to drop to dangerously low levels, usually resulting in dizziness, fatigue, and damage to organs. This can occur when skipped a meal or taking to much insulin.
Transactional model for feeding disorders
Posits that feeding disorders arise through parent-child interactions characterized by children and (a) high physiological arousal and (b) difficult temperament, and (c) parents who are anxious about their child's food intake
Tripartite influence model
Posits three risk factors for the development of eating disorders: (1) peers, (2) parents, and (3) the media; these factors lead to internalization of the thin ideal, social comparison, and body dissatisfaction over time.
What medications are prescribed for enuresis?
-Desmopressin (DDAVP): Most commonly prescribed medication for nocturnal enuresis. -Strattera: Used for ADHD but helps childrens sleep arousal-awareness of full bladder sensations thus inhibiting nightime wetting.
How do Pediatric Psychologists help children with Diabetes Mellitus?
-Help children adhere to treatment -Teach younger children strategies to reduce pain, to respond to teasing peers, to work with parents to find ways to avoid arguments about adolescents diet.
What can pediatric psychologists?
-Help children and families adhere to medication -Overcome anxiety and mood problems -Improve social competence and skills
What are sleep problems associated with?
-Impairment in attention, concentration, and problem solving -Behavioral and academic difficulties in school
What is the difference between nightmare and sleep terrors?
1. Nightmares occur during REM sleep, sleep terrors occur during non-REM sleep. 2. Children can be awakened during their nightmares, not with sleep terrors. 3. Children can recall the content of their nightmare, unable to recall the content of a sleep terror. 4. After a nightmare falling asleep, is difficult but after sleep terror children return to sleep. 5. Nightmares are associated with stress and trauma however sleep terrors are not.
Circadian Rhythm Sleep Wake Disorder
A DSM-5 disorder characterized by a persistent or recurrent pattern of sleep problems caused by a mismatch between the person's typical sleep wake pattern and the schedule required by the persons school or work.
Insomnia Disorder
A DSM-5 disorder characterized by predominant difficulty or dissatisfaction with sleep quantity or quality associated with problems going to sleep, remaining asleep, or returning to sleep; occurs at least 3 nights per week for 3 months and causes distress or impairment.
Nightmare disorder
A DSM-5 disorder characterized by repeated, extended, and upsetting dreams that occur during REM sleep, typically involve threats to personal security, and cause distress or impairment; the person can be easily awakened and has vivid memory of the dream.
Encopresis
A DSM-5 disorder characterized by the repeated passage of feces into inappropriate places whether involuntary or intentional; the individual must be at least 5 years of age and the act must occur at least twice per week for 3 months and cause distress or impairment.
Feeding Disorders
A class of DSM-5 disorders characterized by a persistent disturbance in eating related behavior that results in altered consumption of absorption of food and that interferes with physical health; includes pica, rumination disorder, and ARFID.
Dichotomous (black or white) thinking
A cognitive distortion in which the individual rigidly views herself, others, and the world as either all "good" or all "bad."
Nightmare imagery rehearsal therapy
A cognitive treatment for nightmare disorder, children rewrite the nightmare in a manner that emphasizes mastery or resilience and then mentally rehearsing the dream daily.
Dual pathway model
Posits that eating disorders develop through two pathways: (1) dietary restriction and (2) negative affect
Continuous positive air pressure (CPAP) device
A small mask connected to a tube and ventilator that provides constant air pressure to keep the individuals airway open during sleep
Supportive Confrontation
A technique sometimes used in inpatient group therapy for eating disorders; senior group members are encouraged to challenge the cognitive distortions and food obsession of newer members.
Polysomnogram (PSG)
Assessment of a child's sleep architecture during the course of the night; involves the monitoring of brain activity (EEG), eye movements (EOG), muscle activation (EMG), and heart rhythm (ECG).
Chronotherapy
Behavioral treatment for circadian rhythm sleep wake disorder; involves gradually advancing or delaying bedtime until persons sleep-wake cycle is aligned with his or her daily schedule.
Refeeding syndrome
Cardiac and other health related problems shown by patients with anorexia during the first 7 to 10 days of treatment.
Appetite manipulation
Children are provided with fluids and essential electrolytes to maintain hydration but are prohibited from snacking between meals; increases the motivation of children with ARFID to eat.
Sleep Arousal Disorders
DSM-5 disorders characterized by recurrent episodes of incomplete awakening during non-REM sleep resulting in either (A) sleepwalking or (B) sleep terrors; the child experiences no dreams during the episode or memory of the episode the next day, but the episode does lead to distress or impairment.
Anorexia Nervosa (AN)
DSM-5 eating disorder characterized by (A) caloric restriction leading to significantly low body weight, (B) intense fear of gaining weight or becoming fat, and (C) disturbance in one's body weight or shape.
Sleep hygiene
Developmentally appropriate behaviors and environmental conditions that promote restful sleep
Electrolyte Imbalance
Disturbance in the minerals found in the body (e.g., calcium, sodium, potassium) that regulate hydration and metabolism; can be caused by purging
Liaisons
In the field of pediatric psychology, mental health care professionals who help members of an interdisciplinary health care team coordinate treatment and communicate with each other and the child's family or school.
Consultation
In the field of pediatric psychology, providing professional advice or assistance to a medical professional regarding an aspect of a child's behavior that interferes with treatment.
Adherance
In the field of pediatric psychology, the degree to which children and families agree with, understand, and follow the recommendations of medical staff.
Hypokalemia
Low potassium levels; potentially fatal; associated with recurrent purging.
Benzodiazepines
Medications that augment GABA and produce marked sedation; can cause tolerance and withdrawl symptoms.
Define observational learning
Participant modeling technique is one of the principles-psychologist demonstrates desired behavior and a child is encouraged to imitate the action.
Osteopenia
Reduced bone mass; often seen in individuals with anorexia.
Diagnostic migration
The tendency of people with eating disorders to change diagnostic classification over time, most commonly from AN to BN.
Define the 2 types of Diabetes
Type 1: In kids, absence or destruction of cells in pancreas responsible for manufacturing insulin. Type 2: 10-20% in youths. Occurs when body develops resistance to insulin and no longer uses it properly to control blood sugar.
Sleepwalking
Type of sleep arousal disorder characterized by the tendency to leave the bed and walk during non-REM sleep; the person usually has reduced responsiveness to others and is difficult to wake.
Monosymptomatic primary enuresis (MPE)
Wet only at night, have never been able to stay dry at night for longer than 6 months and have no known medical cause for their wetting. Usually wet soon after falling asleep, void a normal amount of urine, and often do not wake up after urination. These children usually do not show any other behavioral or emotional problems.
Bulimia Nervosa (BN)
A DSM-5 eating disorder characterized by (A) recurrent episodes of binge eating, (B) recurrent inappropriate compensatory behaviors to prevent weight gain, and (C) self-evaluation that in unduly influenced by one's body shape or weight; occurs at least once a week for at least 3 months.
How do Pediatric Psychologists help children with Cystic Fibrosis?
-Help children and their families adhere to physicians' recommendations regarding the frequency of exercises to clear their airways and lungs -Teach parents to use positive reinforcement and other behavioral techniques to increase children's compliance- may be defiant during exercises. -Challenge the maladaptive cognitions of adolescents and increase their motivation to manage their condition- may become depressed.
What can pediatric psychologists do to help someone with Juvenile Rheumatoid Arthritis?
-Help patients manage chronic pain -Develop ways to increase children's adherence to medication and their exercise-physical therapy program. -Work with parents and siblings to help reduce stress and conflict within the family.
What are the causes of Monosymptomatic Primary Enuresis (MPE)?
-Heritability -Arginine Vasopressin (AVP): hormone tat increases urine concentration and reduces total urine volume. -Sleep arousal- responding to signals of full bladder when asleep. -Lack of inhibition from pelvic floor to stop urination when full bladder is detected.
What is the treatment of nightmare disorder?
-Assessment of possible psychosocial stressors -Improving the child's sleep hygiene -Teaching children relaxation and coping skills
What is Sickle Cell Disease and how can pediatric psychologists help youths with this disease?
-Characterized by abnormal, sickle cell red blood cells. Has an unusual shape which causes blood flow problems. Recessive genetic disorder. -Pediatric Psychologists can help teach techniques to manage pain, deep breathing, guided imagery, positive self-statements, and help children and families cope with other stressors associated with the disease (missed school, sleep issues, restricted social activities).
The behavioral interventions used by pediatric psychologists are based on (3) things:
-Classical Conditioning -Operant Conditioning -Observational Learning
Cognitive interventions work better with older children who have the ability to think about their own thinking. What are some cognitive techniques used in cognitive therapy?
-Cognitive restructuring: Used to change distorted, inflexible thoughts, to move realistic, flexible cognitions. -Role-play and self-statements: Act out situation that produces negative feelings and action/thoughts. Practices replacing distorted thoughts. -Guided Imagery: Replacing thoughts with pleasant ones. Combo of relaxation techniques. -Refocusing: Redirecting attention from stressful or painful events to more relaxing or entertaining stimuli.
What is Systematic Desensitization?
-Common intervention used to help children cope with painful uncomfortable medical. Very commonly used with phobias. -1st: Teach children to relax -2nd: Child lists stimuli that elicit anxiety, puts in hierarchial order/ratings. -3rd: Child engages in imaginal exposure -4th: In-vivo (real life) exposure. You gradually progress up hierarchy till successful medical procedure done.
What are the characteristics of sleep-wake disorders?
-Disruptions in a persons sleep patterns -Dissatisfaction regarding the quality, timing, or amount of sleep -Cause distress or impairment during the day
How do Pediatric Psychologists help children with Asthma?
-Educate families about it -Help modify the home environment to prevent attacks -Teach ways to cope with asthmatic episodes (deep breathing, relaxation exercises, guided imagery).
List and describe the treatments often used in Medical Settings?
-Family Therapy: To foster coping and resiliency. Based on systems theory that the individual can cope with his environment-dependent on many relationships with others in their life. -Structural Family Therapy: Concerned special relationships, or alliances, between parents and children, and also with boundaries between the family and the outside world (problems occur with enmeshment or disengagement). -Behavior family systems therapy (BFST): Combines CBT interventions with elements of structural family therapy. Used to reduce conflict and increase communication. Problem solving and communication skills training to families. Identify and challenge biased or irrational beliefs held by family members contributing to family conflict. Identify and correct alliance or boundaries. -Multisystemic Family Therapy (MFT): Used to improve family cohesion and communication. Reducing conflict, miscommunication, and coercive parent-child interactions. -Group and peer assisted therapy: Used to enhance social support. Children get to encounter youths with similar medical problems, children practice skills with eachother, and children receive feedback from their peers. Also reducing feeling of isolation.
What is the difference between Irritable Bowel Syndrome (IBS) and Irritable Bowel Disease?
-IBS: Abdominal discomfort, altered bowel functioning. Either diarrhea or constipation (less severe) -IBD: More severe. Diarrhea, rectal bleeding, abdominal cramping, weight loss, fatigue, and fever. Crohn's disease= the best example of IBD. Cause is unknown-likely influenced by genetics, exposure to bacteria or viruses, issues with immune system.
What is the most common sleep problem experienced by youths? What are the 2 forms?
-Insomnia Disorder 2 kinds: -Can't get to sleep -Gets up and can't get back to sleep
How do Pediatric Psychologists help children with Cancer?
-May help families cope with fears and worries -May work with families to reduce conflict and increase cohesion among family members during treatment. -Help children plan for their return to school and cope with missed work and peers. -Counsel children who experience specific problems, such as depression, pain management and nausea.
What are three methods of Extinction?
-Planned ignoring: Parents ignore the infant until he falls asleep independently. This works more quickly than others. -Graduated ignoring: Variations of times of waiting to console the infant. (5, 10, 15,) -Bedtime fading: Child is placed in crib 30 minutes later than bedtime. If the infant does not get to sleep quickly, you wake the infant up for 30 more minutes then put them back into the crib to see if they falling asleep quickly. The next night, you start doing this 30 minutes before the desired bedtime and continue this pattern until they start falling asleep quickly at their bedtime.
What are the associated problems with Encopresis?
-Report less satisfying relationships, greater sadness, and more separation and social activities. More likely to have behavioral or social-emotional problems. At risk for low-self esteem and social problems. -Secondary encopresis: associated with oppositional and defiant behavior.
What is Operant Conditioning?
-Used to increase children's adherence: 1)Positive Reinforcement: Awarding points, increasing behavior. 2)Negative Reinforcement: Excusing the child from the chore (reward), Increasing their behavior 3)Response Cost: Removal of behavior points.
Avoidant/Restrictive Food Intake Disorder (ARFID)
A DSM-5 feeding disorder characterized by (A) lack of interest in feeding, (B) avoidance of food based on its sensory qualities or (C) concerns about negative consequences of eating; causes weight loss, nutritional deficiencies, or other health/social impairment.
Pica
A DSM-5 feeding disorder characterized by persistent eating of nonnutritive, nonfood substances over a period of at least 1 month; must be developmentally and culturally unexpected.
Rumination Disorder
A DSM-5 feeding disorder characterized by repeated regurgitation of food over the period of at least 1 month; must not be attributable to a medical condition or purging behavior shown by people with eating disorders.
Obstructive Sleep Apnea Hypopnea
A DSM-5 sleep wake disorder characterized by recurrent breathing disruptions (apneas) or episodes of shallow breathing (hypopneas) during sleep that leads to breathing disturbance (e.g., gasping, snoring) or daytime sleepiness.
Pica box
A box containing foods that have similar sensory properties as objects that are eaten by the child with pica.
Cholecystokinin (CCK)
A hormone that is secreted by the small intestines that signals satiety and reducing eating in healthy individuals.
Failure to thrive (FTT)
A medical condition characterized by nutritional deficiency and weight below the fifth percentile for age and gender on standardized growth charts.
Maudsley Hospital Approach
A method of treating youths with AN; components include (a) initial refeeding by parents, (b) structural family therapy to improve communication, and (c) increased autonomy for the adolescent.
Binge Eating Disorder (BED)
A DSM-5 eating disorder characterized by (A) recurrent episodes of binge eating, (B) recurrent inappropriate compensatory behaviors to prevent weight gain, and (C) self-evaluation that in unduly influenced by one's body shape or weight; occurs at least once a week for at least 3 months.
Urine Alarm
A small mechanical device worn in children underpants in an area most likely to become wet during the night. Device is battery operated and connects to a small alarm that is clipped to children's pajamas. When children wet, urine completes an electrical circuit in the mechanical device, which triggers the alarm. Alarm typically wakes children, who become aware of their nighttime wetting. Believed to stop urination through classical conditioning. The alarm naturally startles the child, causing contraction of the muscles on the pelvic floor. This contraction inhibits urination. The classically conditioned response (CR) is maintained through negative reinforcement or avoidance learning. Over time- child learns to avoid signaling alarm by contracting pelvic floor muscles when sensing a full bladder.
Enmeshment
A term used by structural family therapists to describe family relationships in which boundaries between parents and children were blurred or diffuse.
Ego-systonic
A term used to describe a condition or disorder that the person does not view as problematic or is consistent with the person's goals and values
Ego-dystonic
A term used to describe a condition or disorder that the person views as problematic, shameful, or is inconsistent with the person's goals and values.
Sleep terrors
A type of sleep arousal disorder characterized by recurrent episodes of abrupt panic and autonomic arousal during non-REM sleep; the child typically lacks responsiveness and is unable to be consoled during the episode; causes distress or impairment during the day.
Cleanliness training
A version of overcorrection used to treat nocturnal enuresis; children must wake, change their pajamas and bedding, and reactivate the urine alarm prior to returning to bed.
Thin ideal
According to social-cultural theories of eating disorders, an unrealistic and culturally constructed notion of the perfect female body that is perpetrated in the media and through social interactions.
Sleep Architecture
An activity of the central nervous system during sleep in typically developing individuals of a certain age; consists of a series of stages of n on-REM sleep usually followed by a REM episode when repeated over the course of the night.
Pediatric Psychology
An interdisciplinary field concerned with the application of psychology to the domain of childrens health.
Voiding postponement
Another reason for daytime wetting. Being so engrossed in other activities and not aware of a full bladder. Urinate infrequently, engage in holding behaviors (fidgeting, crossing their legs), and must be prompted by adults to use the toilet.
How do you treat infants and children with insomnia?
Behavior therapy consisting of: -Consistent in sleep schedule (bedtime routine- bathing, etc and the same sleep time) -Extinction: Placing the child in the crib without a stimulus (reinforcement) to learn self soothing skills to get to sleep.
How do you treat Encopresis?
Behavior therapy which begins with: -Explanation of causes of encopresis -Rationale for the interventions provided -Dietary changes prescribed -Child participates in scheduled toilet sitting (positive reinforcement, cleanliness training and response cost-withdrawing reinforcement after accident and cleaning soiling) -Behavior interventions used in combination with laxatives.
What is the cause of Polysymptomatic Nocturnal Enuresis (PSNE)?
Bladder instability- uninhibited bladder contractions during the night, which prompt them to release urine. Small functional bladder capacities; able to hold in less urine before feeling the need for excretion.
How do you treat older children with insomnia?
CBT -Beginning with sleep hygiene (avoiding caffeine and other substances that inhibit sleep, avoid highly stimulating activities prior to bedtime). -Relaxation Training: Progressive muscle relaxation, guided imagery, focused breathing. -Stimulus control: Doing homework, socializing, etc. away from bed. Bed associated for sleep. -Sleep restriction: Limiting the number of hours in bed. -Cognitive Restructuring: Correct maladaptive thoughts. 1) Identifying irrational beliefs. 2) Challenge validity of beliefs. 3) replace beliefs (incorrect) with rational ones. -Medication
Polysymptomatic Nocturnal Enuresis (PSNE)
Children with PSNE tend to wet throughout the night, void small amounts of urine, and wake after wetting. Tend to wet during the day and complain of frequent sudden urges to wet.
Sleep-wake disorders
Class of DSM-5 disorders characterized by disruptions in a person's sleep patterns or dissatisfaction regarding the quality, timing, or amount of sleep; causes distress or impairment during the day.
Full spectrum home training (FSHT)
Clinicians may turn to this if the urine alarm does not work. Five components: 1) education and behavioral contracting (Teaching family about nocturnal enuresis and giving a behavioral contract of roles- avoiding scolding, do not allow child to wear pull ups and do not restrict fluid intake). 2) Urine alarm training (Each night the child stays dry, gets a sticker on reward chart. Nights of not staying dry- they must wake up, turn alarm off and go to the toilet to urinate). 3) cleanliness training: After waking from alarm, child is expected to remove bedding and pajamas and place them in the laundry. Then expected to put on new bedding and pajama, reactivate alarm, and return to bed. 4) retention control training: Increase child's functional bladder capacity so that they can wait longer before urinating. The child drinks a large cup of water and tries not to go to the bathroom for 3 minutes. This occurs each day, while also increasing the time they are able to refrain from urinating until they reach 45 minutes. 5) overlearning: Designed to prevent relapse by giving children more practice associating full bladder sensations with the contractions needed to inhibit urination. Gradually increases amount of water consumed before bedtime without wetting during the night.
What are the causes of insomnia in children?
Comprehensive models assume that insomnias depend on: characteristics of the child, the parent, and the interactions between both members of the dyad. Other causes are: difficulty falling asleep alone (co-sleeping with infants), night walking, bedtime resistance or struggles (curtain calls), anxiety ot impulsivity (catastrophizing, selective abstraction, personalization) and ADHD.
Arginine Vasopressin (AVP)
Hormone that increases urine concentration and reduces total urine volume. Low AVP may cause nightime urine production to exceed childrens bladder capacity.
Antihistamines
Medications that block the naturally occurring neurotransmitter histamine and cause drowsiness and sedation; examples are diphenhydramine (benadryl) and hydroxyzine (Vistaril)
What are the causes of Encopresis?
Mostly caused by constipation and overflow incontinence. -Distracted by other activities -No easy access to a toilet -Diet may be restricted or irregular Periods of prolonged stress
Perfectionism
Personality trait sometimes shown by youths with anorexia; characterized by a rigid and unrealistic pursuit of absolute standards of behavior (athletics, academic, social); associated with excessive compliance, a strong desire to please others, and a lacking an autonomous sense of self.
What are the two types of Encopresis?
Primary Encopresis: A term used to describe encopresis exhibited by a child who has no history of bowel control. Secondary Encopresis: A term used to describe encopresis exhibited by a child who formerly showed appropriate toilet use.
Name and define the 2 types of Enuresis.
Primary Enuresis: Seen in children who have never been able to stay dry during the night or day. Typically children do not have any other behavior or emotional problems. Secondary Enuresis: Seen in children who had previously been toilet trained for at least 6 months and then began to show enuresis. Sometimes children with secondary enuresis show ADHD and oppositional behavior. Typically secondary enuresis follows a stressful event (moving for example).
Enuresis
Repeated voiding of urine into the bed or clothes in children aged 5 or older. Diagnostic Criteria: Voiding must occur at least twice a week for 3 consecutive months. Voiding must not be caused by medications such as diuretics.
What are Kegel Exercises?
Repeatedly stopping and starting the flow of urine during a toileting episode.
Desmopressin (DDVAP)
The most commonly prescribed medication for nocturnal enruesis; a synthetic version of vasopressin, the hormone that reduces nighttime urine production.
What questions do parents need to ask if they are concerned that their child could have a sleep-wake disorder?
They need to be assessed through parental report (could be a sleep log or diary to record childrens sleeping and waking) using the BEARS acronym: -Bedtime difficulties (Going to bed, staying in bed) -Excessively sleepy -Awaken during the night -Regular sleep wake-schedule -Snoring
What are the 3 daytime wetting treatment components?
a) help children recognize feelings of a full b ladder (scheduled bathroom breaks, praised/reinforced when stays dry). b) increase their control over pelvic floor muscles (kegel exercises practiced at least 3x per day). c) Increase their functional bladder capacity (Helping children hold more urine and decreasing frequency of urination).
