HDE 130 Exam 3

Financial Cost of Maltreatment

$50-100 billion. this is an underestimate. does not account for indirect costs.

Binge Drinking

5 or more drinks for men, 4+ for women.

ocd and meds

both tricyclic antidepressants and ssris are good.

Brain and endocrine functioning PTSD

*Amygdala, Hippocampus and HPA axis* play vital role in the development of PTSD. so chronic overactivity of HPA axis. actually show lower resting cortisol which is a result of overactivity of HPA axis. High levels of cortisol damage the hippocampus which is involved for memory. small intracranial volume and reduction in the size of the corpus callosum.

Deviance Prone Pathway

*Neurobehavioral disinhibition*, academic problems, deviant peer groups. -neurobehavioral inhibition is marked by: behavioral under control, emotional reactivity and lack of executive function. early maturing girls! -academic and peer problems like deviant peer groups

Cannabis

*THC receptors are largely found in basal ganglia, cerebellum, hippocampus and cortex*. Depends on where the THC is detected-in basal ganglia more movement and coordination effects. In hippocampus, more memory effects. Effects: *GABA, NE, dopamine, glutamate and serotonin*. usually reduces metabolic and neurotransmitter activity. most people show acute tolerance to marijuana.

Pharmacological criteria

*Tolerance*=when a person needs more of a substance to achieve intoxication or the same amount of the substance produces diminished effects over repeated use. *Withdrawal*=a person experiences negative physiological symptoms when they stop or reduce substance use or take a different substance to avoid negative symptoms.

Treatment for Child Sexual Abuse

*Trauma focused CBT!!* goal is to manage negative emotions. identify positive and negative emotions first for neutral situations and then realize that negative emotions are ok. then they describve their own trauma. *thought stopping*= say no when unwanted thoughts come in the head. explore different ways of thinking about it. read books by other kids who were abused. therapist has the kid challenge maladaptive thoughts. parent gets their own therapy, then bring the non offending parent and child together. child reads the story. this is more effective than supportive therapy!!

GAD Definition

*apprehensive expectation* is the hallmark feature!! excessive anxiety and worry about the future. youths with GAD must worry about at least 2 activities or events. people with and without GAD worry about very similar things. GAD is distinguished from regular anxiety by its number, intensity and duration. 1. people with GAD report higher number of worries. 2. people rate their worries as more intense 3. spend greater percentage of their day worrying than most other individuals.

contingency management and phobias

*contingency management* based on the principles of operant conditioning. involves exposing the kid to the feared stimulus and positively reinforcing the child contingent on the exposure. kid is NOT allowed to avoid or withdraw from the feared stimulus.

BEIP and DSED

*lack of inhibition and not attachment*. not consistently associated with the quality of care infants got. thad rouble with attention and social inhibition later on. high number of foster care caregivers=higher inhibitory control problems. kids in foster care in general had more inhibitory control problems.

12 step philosophy/program

*most common form of SUD treatment in US!!* AA is an example. so alc use is a disease and medical condition. first acknowledge that they have a problem. effective for adults but not known to be effective for teens. High rates of relapse. 60% relapse in 3 months and 80% relapse in one year.

Family therapy

*most extensively studied treatments for adolescent substance use* the substance use is a family problem. how relationships with parents, home environment and school influence substance use. so help parents manage adolescents substance use which involves education about norma and atypical adolescent development. also improve overall quality of family functioning. MULTIDIMENSIONAL FAMILY THERAPY: targets 4 main dimensions of family functioning: a) adolescents substance use, b)caregiving practices by parents c) quality of parent child relationship d) other social factors that can influence the adolescents substance use like peer relationships. so individual sessions with parents and adolescent and then group family sessions over course of several months. Effective!

Specific Phobia

*the most common and untreated anxiety disorder in children and adolescents*. marked fear of clearly discernible circumscribed objects or situations. animals natural environment (thunderstorms, heights, water) blood injections and injuries specific situations other stimuli-fear of choking, contracting an illness, costumed characters. must be out of proportion to the actual danger posed by the situation or object. -young kids seem to fear concrete objects such as animals and monsters. older kids tend to fear situations that might result in jinjury to themselves or others. girls are more likely than boys to develop most types of phobias. however, situational phobias, like fear of heights are equal for girls and boys as well as the blood injection phobia. 75% of youths who have one specific phobia have another. *most common comorbid is fear of social situations and SAD*. generally last 1 to 2 years, most childhood phobias don't persist into adulthood.

Chronic Worry: GAD

*unlike other anxiety disorders in two respects. 1st, GAD is characterized by worry rather than fear or panic. Second, GAD is more closely associated with depression than other anxiety disorders.*

Enhanced reinforcement Pathway

-*genetic diathesis*=parents who use lots of substances have kids who use lots of substances esp. biological fathers. -*Positive Expectations* and pleasurable Effects: enhanced reinforcement pathway assumes that biological diathesis makes offspring unusually sensitive to the pharmacological effects of substance. eventually expect that the substance will have positive effects

Pathways to SUDs

-Enhanced Reinforcement Pathway -Negative Affect Pathway -Deviance prone pathway

Primary Prevention Programs--target all youth

-D.A.R.E.=school based program designed to prevent substance use problems. Weekly visits by uniformed police officers to schools. Does not appear to be effective in reducing alcohol and other drug use. So increases their knowledge about substance use but didn't cause changes in the children's substance use. -Media Campaigns: PDFA television ads designed to provide drug ed to youths and parents. Successful at reaching large number of families. Not clear if effective. -*White House Office of National Drug Control Policy:* television ads again and was designed to increase parent child communication about drugs, increase parental monitoring and decrease positive beliefs about drugs, and decrease the actual use. OUTCOME: reached large number of families and increased parent child communication but was largely unable to increase parental monitoring or decrease substance use. There was an actual INCREASE in kids intentions to use weed! (Teratogenic effect!)

most common PTSD symptoms in children

-avoidance of people/places -irritability, tantrums

OCD specifiers

-good or fair insight=recognize that ocd beliefs are definitely or probably not ture or that they may or may not be ture -poor insight=the individual thinks that ocd beliefs are probably true -absent insight=the individual is completely convinced that ocd beliefs are true -tic related=the individual has a current or past history of tic disorder.

CBT

-identify the bad behavior and underlying cognitive distortion, then show people that those things are actually bad for you. -People learn to use alcohol through OPERANT CONDITIONING. Alcohol is positively reinforcing and negatively reinforcing. -Thru CLASSICAL CONDITIONING, learn to associate the substance use with certain situations or mood states. so use weed with certain friends and then they are like a stimulus cue to use again. -Substance use is maintained through SOCIAL LEARNING. family and peers model and reinforce drug use. -BELIEFS mediate the relationship between events that trigger substance use and consumption of alcohol and other drugs. so their interpretations and thoughts about events lead to either substance use or abstinence. So CBT targets all of these four ways. 1. monitor substance use and environmental factors that precede it. 2. encourage teen to consider consequences of drug use. cost benefit analysis. 3. help them avoid substance use by reinforcing the effects of alcohol. 4. examine the beliefs of the kid about substances and challenge distorted cognitions that lead to problematic use. CBT is efficacious!

SUDs symptoms clusters

-impaired control -social impairment -risky use -pharmacological criteria

different obsessions and different brain pathways

-people who had obsessions about germs when watched pictures of hand washing they showed increased activation in the insular cortex, a brain region in this pathway involved in the emotion of disgust. -counting obsessions in the cingulate.

Social impairment

-recurrent failure to fulfill major role obligations--miss school or work -continued use despite recurrent interpersonal problems-argue with parets -important activities are given up

Intrusion symptoms

-recurrent memories or dreams about trauma -dissociative reactions -marked distress or physiological responses to reminders of trauma.

Risky use

-recurrent use in physically hazardous situations -continued use despite physical or psychological problems

effects of Sexual abuse

-traumatic sexualization: actions that are either not typical for the child's age or inappropriate for the social situation. age innaprpriate behavior is NOT a reliable indicator of sexual abuse. *precocious sexual knowledge* may be a better indicator. can speed up sexual maturation esp. in girls. girls at higher risk for sexual disorders later on and being revictimized. boys and girls have more sexually risky behavior. boys can have sexual disorders as well, but not more likley to be victimized later on except homosexual men. -feelings of betrayal: sexual abuse breeds mistrust. mistrust towards adults in general. anger, rage, anxiety. insecure attachment. -powerlessness: esp. kids with internal, stable and global attributions for their bause. PTSD most common. -stigmatization: believe they are damaged goods. engage in self distructive behaviors. suicidal thoughts. boys who are sexually abused have direct relationship to suicide while girls do suicde through depression.

ocd in children and adolescents

1-2% of kids and teens have ocd. 90% of these kids are not receiving treatment for the disorder. in childhood, more common among boys than girls with gender ratio of 2:1. then by late adolescence, many girls begin to manifest the disorder and the gender distribution becomes roughly equal. most common obsessions are fear of germs, fear of harm befalling self or others and an overwhelming need for order or symmetry. most common compulsions are wahsing and cleaning, checking, counting, repeating, touching and straightening.

maltreatment

1-2% of kids confirmed victims of maltreatment. substantiated cases. a lot of these reports are thrown out due to lack of evidence etc. so underestimate.

BIPHASIC Effects of alc

1. Mild to moderate use produces one set of largely desirable effects: increased arousal, sociability, euphoria and reduced anxiety. *Stimulation of NE and Reticular Formation*-POSITIVE REINFORCEMENT 2. Extended use produces different effects: reduced anxiety and stress, sedation, cognitive and motor impairments, heat and respiratory problems and other health risks. *disrupts glutamate receptors* -NEGATIVE REINFORCEMENT.

Parenting

1. Monitoring! 2. Sensitive and responsible care and discipline their kids in consistent and non coercive manner can reduce the likelihood of their kids substance use

Why the Change from DSM-4 to DSM-5?

1. Symptoms fall along dimension rather than two categories. 2. Most people who abuse substances never become dependent. 3. With DSM-4, many people were diagnosed with alcohol abuse after showing only one symptom: drinking while driving. 4. DSM-4-some people with serious alc problems and drug problems did not meet criteria for either abuse or dependence. "diagnostic orphans" only show 2 and not 3 dependence. So "substance-related legal problems" was removed for DSM-5 and the combination of the rest of the symptoms were put together. Cravings was added. Also increased symptom threshold from Abuse which was only one to 2 now (for Substance Use disorder). Designed to exclude people who might have been erroneously diagnosed with substance abuse.

Triple Vulnerability model for anxiety

1. genetics and biological risk that is largely heritable-temperament and disruptive brain circuits. 2. early social emotional experiences that give kids a sense of vulnerability or lack of control-prenatal or postnatal. parent child attachment. internal working model of what to expect from relationships, or highly violent community. may expect the world to be an unpredictable dangerous place, so now you always hypervigelent which can contribute to "learned helplessness" or external locus of control<--unpredictable is scary!! difficult to cope. 3. specific environmental experiences that can determine the nature of the kids fears.-embarrassing event, traumatic experience (being attacked by dog)

neglect

1. physical 2. emotional 3. medical 4. educational

Types of psychological stressors

1. traumatic experiences 2. early social and emotional deprivation 3. child maltreatment not mutually exclusive.

Attachment and Biobehavioral Catch up (ABC)

10, one hour sessions for parent child dyads. 3 components: 1. parents are taught to meet infants needs even when these needs are not clear 2. parents are encouraged to give infants greater autonomy in parent child interactions and be sensitive to needs and signals during play. so self direction for the infant is important! Real time coaching to parents. 3. therapists help parents overcome barriers to meeting their children's needs in sensitive and responsive ways. parents who hvae expiernced neglectful parenting themselves may have difficulty meeting their infants needs. is efficacious!

General Prevalence of Anx

15-20% of youth will develop an anxiety disorder by adulthood. most prevalent mental health problem among kids!! adolescents and girls are at greatest risk. *modest homotypic continuity and strong heterotypic continuity*. if anxious as children anxious as adults (homotypic). in terms of what specific anxiety disorder we qualify for, its going to change over time (heterotypic). so SAD as a young child and then social anxiety as an adult. highly stable in general. can lead to depression. depression has peak onset in early adolescence so anx early on then leads to depression.

CBT and SAD, Social anxiety and GAD

16 week long program for kids. divided into two phases: education and practice. so kids learn about the relationship between thoughts feelings and actions and they are taught new ways to cope with anxiety and worry. cbt is effective! also most effective when kids and parents are involved, not just kids.

Early Developmental Stages of psychopathy study

25%-30% of kids diagnosed with specific anxiety disorder at baseline met diagnosiic criteria for the same disorder 10 years later (homotypic) and 70% met criteria for an anxiety disorder or mood disorder 10 years later (heterotypic.

Depression and Anxiety and SUDs

25%-50% of adolescents with substance use problems are depressed. Mood disorders often develop after the onset of SUDs. -Shared genetic and psychosocial risk factors. -adolescents show greater likelihood of suicidal thoughts when you have substance use problems. alc can produce feelings of dysphoria by lowering the inhibitions against self harm and increasing risky behavior -*Comorbid Anxiety=some anxiety disorders like social anxiety precede SUDs. Other anxieties like GAD actually develop after chronic use of alc.* depression tends to develop AFTER substance abuse. <--adolescent vs. childhood onset and withdrawal.

Prevalence of PTSD

30% of youths are exposed to serious, traumatic event at some point in their childhood and 1/3 of these kids will develop symptoms of PTSD. even less of these will meet full diagnostic criteria. so (.1%) have PTSD. probably an underestimate because these are only diagnosed kids. hard to diagnose kids.

Associated disorders SUD

50% of adolescents in community with SUD show at least one other mental disorder. Among adolescents referred to treatment, comorbidity ranges from 50-90%. adolescents with dual diagnoses show more school related difficulties, greater family conflict, more emotional distress and more legal problems. show poorer prognoses! more likely to drop out of treatment and less responsive to treatment.

Medication

55% of kids who receive treatment for suds are prescribed at least one med. 1. Substitution therapy: administering meds that is designed to eliminate cravings (methadone for heroin addicts, nicotine patch) 2. Detoxification: meds can be used to help with withdrawal symptoms. 3. Block the effects of alc and drugs, reduce their pleasurable consequences 4. aversion therapy=antabuse med makes you sick when you drink alc. and helps people reduce alc consumption 5. most common!! treat comorbid disorders like depression and ADHD. however, have little effect on alcohol consumption. can also abuse these meds.

Costs of Substance Use in US

Americans spent $100 billion a year on illicit drugs from 2000-2010. In 2007, elicit drug abuse cost 193 billion in lost productivity, health care and criminal justice . Tobacco use=295 billion a year Alcohol abuse=224 billion a year. *More tax money spent on alc and substances than public school edu* -majority of money spent on treatment and only 13% spent on prevention.

Bucharest Early Intervention Project (BEIP)-RAD

Bucharest Early Intervention Project (BEIP): longitudinal study. RAD is associated with lack of attacment in infancy and early childhood. quality of care is inversely related to RAD severity. foster placement is helpful in reducing RAD over time.

Comparison of Treatments

Cannabis Youth Treatment Study suggest that five sessions of MET/CBT can be sufficient to treat SUDs and family therapy is probably an important supplement to MET and CBT interventions.

CBT and OCD

CBT is treatment of choice for ppl with ocd. -information gathering -exposure and response prevention -generalization

most supported treatments

Contingency management and participant learning. real stimulus and positive reinforcement=dont allow patient to engage in avoidant behavior

Problems diagnosing substance use disorders in Adolescents

DSM-5 criteria are developmentally insensitive. Symptoms most commonly seen in teens who misuse/abuse alc. and other drugs are absent from DSM-5 Criteria: -low grades and truancy are not symptoms yet common among teens so these are more developmentally appropriate: breaking curfew, lying to parents, showing reduction in grades and engaging in truancy.

Anxiety Disorders across childhood

Early or middle childhood: -SAD, Specific phobia and Social Anxiety Disorder. Recurrent, unwanted fears of specific objects of situations. "fear disorders"-*conditioned FEAR*-socialized through experience and develop maladaptive response. learned. maintained through negative reinforcement. Adolescence/early adulthood (extremely rare in childhood): -Panic Disorder -Agoraphobia.--fear situations in which escape might be difficult or embarrassing. known as feelings of intense apprehension, dread or panic. Panic and agoraphobia often co occur. GAD: *different from all the other anxiety disorders in that it is characterized by persistent worry rather than fear or panic*. Youths with GAD dont have specific fears of situations or events or objects. they just chronically worry about future misfortune. GAD usually develops around late childhood and early adolescence.

SAD

Fear of separation tends to emerge in infants at 6 months and peaks between 13 and 18 months, declines between ages 3 and 5 years. in young kids, most common comorbid problems are specific phobia and ODD. in older kids, SAD often occurs with GAD and social anxiety disorder as well as sleep problems and bed wetting and sleep terrors. Not as much OCD and mood disorders comorbid.

Etiology of Anxiety

HERITABILITY: modest heritability for most anxiety disorders. many show abnormalities in the CNS or endocrine system. Dysregulation in the *amygdo-cortical neural circuit*. This circuit consists of amygdala and ventromedial prefrontal cortex (modulates fear and controls behavior). So HYPERSENSITIVITY in amygdala and UNDERACTIVITY in VPFC. TEMPERAMENT: -high on neuroticism -high on behavioral inhibition (shyness) EARLY EXPERIENCE: parents who model anxiety, show low warmth overprotective. modeling.

HPA Axis

Hippocampus+amygdala-->Hypothalamus->CRH->Pituitary->ACTH->Adrenal-->CORT and NE and E (Adrenaline). *NE and E has faster response than CORT! cort is slower and builds up over time* negative feedback loop! So levels of cort get so high that it is detected by the pituitary hypothalamus and shuts down the system and stops production of CRH and ACTH to bring person back to homeostasis.

Changes from DSM-4 to DSM-5 SUDs

In DSM-4, SUDs were split into two categories: Substance Abuse and Substance Dependence. -Substance Abuse was considered less severe and was defined by the first three symptoms of the current diagnostic criteria and a fourth criteria=substance related legal problems. Only needed 1 symptom to be diagnosed. -Substance Dependence-more severe if a person met criteria for dependence they would not be diagnosed with abuse. Dependence was the remaining criteria except the presence of cravings. 3 symptoms were required for dependence. Why this distinction? Used to think that SUDs was in two categories: one was that you abused alc and other drugs and had immediate problems with recurrent use. The other was that people who were physically and psychologically dependent on drugs had problems due to prolonged use.

Epidemiology

In general, substance use has decreased over the past decade with greatest reductions for drugs like weed, LSD, meth and ecstasy. Occasional alc use among teens is steady over the years and use of other drugs like prescription is on the rise among teens. Boys usually begin using cigs, alc and other drugs earlier than girls. More likely to binge drink and engage in dangerous activities as a result of their substance use and get in more trouble at school. boys more likley to show comorbid disruptive behavior. girls report greater emotional disturbance than boys, show more comorbid anxiety and depression and physical complaints girls more likely to have histories of family problems and sexual abuse.

Anxiety and development

In order to establish basic trust in primary caregiver need: Emergence of object permanence (4-10 mos) stranger anxiety (6-12 mos), separation anxiety (12-18 mos). advances in cognitive abilities fuel anxieties!! more worries and anxiety. being able to have abstract thinking, future orientation, perspective taking, metacogntiion. catastrophic thinking, self consciousness, insecurities, self doubts.

Physiological Effects of Alc

Metabolized primarily by the liver. Enzymes alcohol dehydrogenase and acetaldehyde dehydrogenase are chiefly responsible for its metabolism. Effects: *NE, Glutamate, dopamine, opioids and GABA*. So first, low doses of alc. stimulate NE causing increased feelings in arousal and behavioral excitation. -inhibit glutamate, slowing neuronal activity=feeling of relaxation and stress reduction. (negative reinforcement) -Dopamine activity!

Specifier=Mild, Moderate, Severe

Mild=2-3 symptoms Moderate=4-5 symptoms Severe=6 or more symptoms

OCD

Psychiatric condition characterized by the presence of recurrent, unwanted obsessions OR compulsions that are extremely time consuming, cause marked distress or significantly impair daily functioning. not an anxiety disorder.

SUDs vs. Substance Use

SUDs only when adolescents repeatedly use alcohol and other drugs in a manner that causes significant distress or impairment. So they are recurrent and effect the adolescents functioning. So drinking and driving once isn't a SUD because not recurrent and repeated weed use is not SUD if its not impairing.

Negative Affect Pathway

Stress can arise from negative early childhood experiences and be caused by later environmental factors. These stressors in turn cause anxiety and depression. may use alc and other drugs to alleviate psych distress. substance use, is therefore negatively reinforced by the reduction of anxiety and depression. however research does not totally support this. often the psychological distress follows the SUD and doesn't precede it. However, specific subsets of people this can apply like abused kids or kids with mood and anxiety disorders.

SUDs and Questionnaires

The CRAFFT questionnaire is often use. C=ridden in a CAR driven by someone on drugs? R=need drugs to RELAX? A=use while you are ALONE? F=FORGET stuff while using the substance? F=do family or FRIENDS tell you that you should cut down? T=have you gotten into TROUBLE while you were using alc or drugs? Can also use the ASSIST Questionnaire-good because screens for a wide range of substance use problems and can be given to both youths and their parents.

Substance Induced mental Disorder

Two classes most common: 1. Depressants such as alc., sedative and hypnotics can elicit depressive disorders over long use as well as anxiety and insomnia upon withdrawal. 2. Stimulants like amphetamines and coke elicit psychotic disorders after use and depressive disorders upon withdrawal. schizophrenia! -alc is technically a sedative

Impaired control

Use in large amounts, problems cutting down, time spent obtaining substance or recovering from effects, craving

GAD in children and adolescents

ability to worry shows around 4 or 5 but the ability to worry about future events doesn't emerge until after age 8. so onset of GAD is between 8 and 10. most common worries: 1. health problems, school problems, disasters, and personal harm befalling on others. children with GAD have manny adultlike worries, such as whether a parent might lose her job or whether the family has enough money. GAD may be overdiagnosed in children and adolescents. many childhood anxiety disorders can be mistaken for GAD. kids with GAD are often called "little adults", they are perfectionists, punctual, and eager to please. self conscious and conform to rules and social norms. "illusion of maturity". need reassurance from others 75% of youths with GAD showed one comorbid anxiety disorder. Most common are SAD, specific phobia and social anxiety disorder. shows closest association with *depression* than any of the other disorders. kids with GAD are at particular risk for developing depression. "fear factor" explains relationship between anxiety disorders characterized by fear and panic like phobia, social anxiety, agoraphobia and panic dosrder. however, a second "anxious misery" factor explains the relationship between GAD and MDD.

quality of attachment

abused and neglected show greater likelihood of developing iNSECURE ATTACHMENT relationships with parents. 2/3 of maltreated kids develop insecure attachment. insecure attachment might medate the relationshio between maltreatment and behvioral/emotional problems. *DISORGANIZED PATTERNS OF ATTACHMENT*=bizzare, erratic and unpredictable ways during the strange situation procedure.

Psychological First Aid

administered by first responders or mental health professionals on site right after the catastrophic event. provides victims a sense of safety and secuirty and meet their immediate social, physical and emotional needs. -foster sense of saftey -promote calming -increase self efficacy. EFFECTIVE!!

Course

adolescents tend to use substances in an orderly, predictable fashion. Gateway hypothesis evidence is limited. could be due to the fact that 1. adolescents with history of impulsive and disruptive behavior are ore likley to use substances, 2. their parents might model excessive substance use. 3. friend's alc use strongly predicts the individuals use. *risk for developing chronic SUDs increases dramatically after high school graduation between ages of 18 and 22 and then decreases by 25 years of age especially among people who attend college.*

adolsecents and adults PTSD

adolescents usually do not experience flashbacks like adults do. they are more likely to have intrusive and recurrent thoughts, images and dreams. nightmares associated with the trauma are common.

Specifer: SUDs and sustained remission

after full criteria for a SUD were previously met, none of the criteria for SUD have been met at any time during a period of 12 months or longer with the exception of craving.

Specifier: SUDs in early remission

after full criteria for a SUD were previously met, none of the criteria for SUD have been met for at least 3 months but for less than 12 months with exception of craving.

Anxity prevalence

among The most frequently diagnosed psychiatric conditions in children and adolescents. 15-20% of kids will develop and anxiety disorder before reaching adulthood. at any given time, approx. 5% of youths have an anxiety disorder. *prevalence of anxiety disorders is higher for adolescents than for children, also higher for girls than boys*. tend to be persistent across childhood and adolescence. specifically, anxiety disorders show *homotypic continuity* (stability for the same specific disorder) and strong *heterotypic continuity (stability for the same general class of disorders)*.

PTSD brain

amygdala, hippocampus, HPA-Axis -Hyperactive--acute episodes of trauama or -Blunted response to stress--more likley to happen to repeated chronic. numbness

*ADHD* IS MOST FREQUENTLY OCCURRING DISORDER WITH SUDS

approx. 15-30% of adolescents with ADHD eventually develop a SUD. about 50%-75% of kids with SUD have ADHD. Have worse prognosis. -Common genetic cause. Problems with executive function and behavioral inhibition. -ADHD and SUDs are correlated with other disruptive behaviors (ODD and CD) -Symptoms of ADHD could increase with the probability of Substance use Problems. so ADHD-->SUDs.

etiology of agoraphobia

approx. 30% of adolescents with panic disorder eventually develop agoraphobia. agoraphobic avoidance is maintained through negative reinforcement. high heritability! often come from families with low warmth, high demandingness and overprotection. Authoritarian parents!! sometimes agoraphobia can develop in the absence of a panic disorder. this can develop in 3 ways: 1. some individuals experience panic like symptoms but not true panic attacks. -ie a child who develops migraines at school. 2. some people develop agoraphobic avoidance of certain places or situations because they experience a negative external, rather and physiological incident in that place. kid bullied at school for example. 3. some people who have agoraphobia also earn high scores on GAD and dependency. seem to worry a great deal about future misfortunes and doubt their ability to code with psychosocial distress.

Phobias aquired

aquired through classical conditioning. think little albert! loud sound with bunny. *MEDIAN RAPHE NUCLEUS* is important for classically conditioned fears!! located in the pons--connected to hippocampus. also aquired through observational learning--learn to fear objects or situations by talking with others or overharing others conversations.

Onset of SAD

around *7 to 9* years of age. can sometimes be response to specific event or often parents are unsure when/why it starts. SAD in childhood is closely associated with Panic Disorder in adulthood. must persist 1 month for youth and 6 months for adults. Common comorbidities: *-Younger kids: Specific phobia, ODD, CD -Older kids: GAD and social anxiety*

acute stress disorder

assigned when people show PTSD symptoms at least 3 days but less than one month. -intrusive symptoms -avoidance symptoms -dissociative symptoms -negative mood -arousal symtpms

parent training for abuse and neglect

attend to childs activities and positvely reinforce appropriate behavior, give clear and appropriate demands, ignore inapprpriate bheaviors and use noncoercieve forms of discipline.

28-day inpatient treatment programs

attend to the immediate medical needs and detoxify, help them recognize the harmful effects of treatment and improve the quality of the relationship with others. require kids to abstain from alc. provide family therapy sessions.

most common symptoms of PTSD shown by kids

avoidance of people/places and irritability/tantrums

omen formation

belief that warning signs immediately preceded the traumatic event. the kid constantly scans the environment looking for familiar signs of impending misfortune. like if a certain song was being played before a car accident, might think the song will indicate another bad thing that is just about to happen. likely formed through classical conditioning.

Institutionalized kids in general

below average height, weight and head circumference. children typically catch up immediately following placement into nurturing foster homes but head circumference remains below average. show dysregulation of HPA axis. can be correctable if children are provided with appropriate care.

Etiology of Panic Disorder

biological, cognitive and behavioral factors interact to produce panic attacks. -may be predisposed to anxiety sensitivity--tendency to perceive symptoms of anxiety as extremely upsetting and aversive.

Anxiety and depression

childhood anxiety predicts MDD, SUDs and suicide attempts. Depression tends to emerge on average 5 years after the onset of anxiety.

systematic desensitization and phobias

classical conditioning! children learn to associate feared stimulus with a response that is incompatible with the fear. usually the incompatible fear is relaxation. same heirarchy thing.

Exposure therapy and phobias

client confronts a feared stimulus for a discrete period of time. over time and across multiple confrontations the clients anxiety gradually decreases. exposure therapy an occur in many ways: gradual=graded rapidly=flooding. real objects people or situations (in vivo) or imagine the feared stimulus. can occur multiple times over a number of weeks (spaced exposure) of over a few hours or days (massed exposure). most effective: in vivo, graded, and massed.

Child-Adolescent Anxiety Multimodal Study (CAMS)

combining CBT with medication will likely improve outcomes. kids who had medication alone showed similar results to kids with cbt alone. people who got combined did best.

Anxiety

complex state of psychological distress that reflects emotional, behavioral, physiological, and cognitive reactions to threatening stimuli.

behavior contract

contract with parents and child and specifies what behaviors the child is expected to performa and what reinforcement will be provided. rank the anxiety.

CBT for panic disorder

currently no evidence based treatment specifically designed for children or adolescents with panic disorder or agoraphobia. for adults, cbt is most effective. -relaxation-reduce physiological arousal when he begins to experience panic. -*interoceptive exposure*-unique to panic disorder. so create the same physiological symptoms of panic and then use relaxation techniques to cope with these symptoms. -cognitive restructuring: what is the worst thing that can happen? -graded in vivo exposure

Amotivational Syndrome

decreased motivation and goal directed behavior. rat study=when having rats complete tasks like navigating a maze, the high ones didnt perform worse, they just weren't motivated with the reward (food).

Alcohol

depressant than enhances GABA and blocks glutamate and produces biphasic effect on the nervous system that results in euphoria and sociability in low doses and slurred speech and coordination problems and cognitive impairment in high doses.

Secondary Prevention Programs--target at risk youth

designed for youths at risk for developing substance use problems. *ecologically based*-target at risk youths in certain areas or neighborhoods. usually designed for middle school kids and early adolescence. sucessful transition from preadolescence to adolescence. -target multiple risk factors simultanously 1. information is provided, taught techniques to avoid substance use 2. parents are taught about drug use problems and how to keep their kids from using drugs. increase parent child comunication and monitorng 3. address the child's larger social system: school, peers and community. Not very effective but *high intensity, comprehensive services reduced substance use more among participants than controls.*

pediatric autoimmune neuropsychiactric disorder assocaited with streptococcus (PANDAS)

develop onset ocd symptoms and tics. autoimmune reaction that causes white blood cells which interfere with the functioning of the striatum.

Etiology of GAD

difficult temperaments, behavioral inhibition, bad parent child interactions. poor problem solving in kids with Gad: -rumination -catastrophising -overgeneralizing -personalizing

prevalence of child maltreatment

difficult to estimate the prevalence of child maltreatment. many cases of maltreatment are never identified. not always reported to authorities. no government agency collects data on all reported cases of child maltreatment. 13.8% of kids have expeinrced at least one form of maltreatment when you look at the potential for harm. harm standard to identify maltreated youths, most common is NEGLECT. then phsycial then sexual then psychological.

ocd maintenance

disorder is probably maintained through learning. obsessions develop when people associate specific evironemntal stimuli with anxiety provoking thoughts or beliefs. reinforced by negative reinforcement. adolescents with ocd show two ways of thinking: 1. adolescents with ocd experience inflated responsibility for their misfortune 2. *thought action confusion*=the erroneous belief that merely thinking about an event will increase its probability. high on neuroticism, overestimating threats to personal security. perfectionists, cognitive rigidity, intolerance of uncertainty. have trouble seeing the world flexibly.

Intoxication

disturbance of perception, wakefulness, attention, thinking, judgement, psychomotor and or interpersonal behavior. doesn't often cause impairment or distress. BUT When a person has distress or impairment due to this, the person can be diagnosed with Substance Intoxication (slurred speech, incoordination, unsteady gate, labile mood, impaired judgement, aggressive behavior, impaired attention, stupor).

Trauma Focused CBT

exposing kids to memories or stimuli associated with the traumatic event and encourage them to think and cope with the trauma in adaptive ways. -educate families on PTSD. -Teach the kid coping skills lie relaxation training. -gradually expose kid to stimuli or memories associated with the traumatic event. ideally the child will eventually be able to share narrative with others. -identify and change maladaptive cognitions. effective!

FEAR plan

feelings-identify feelings and somatic sensations associated with anxiety. expectations-modify and recognize negative thoughts attitudes results so try to reduce negative thinking--goal is not really to increase positive thinking use graded exposure

use cognitive restructuring for older adolescents

fin

Etiology of Phobias

genes play a pretty small role in the development of most phobias. HOWEVER, blood injection-injury phobias seem to be much more heritable. due to unusual activation in *occipitoparieteal cortex and thalamus* -->sensitivity of the *vasovagal response*-which involves rapid increase and sudden decrease in BP. -So there is also different brain activation for blood injection than other phobias. for example, for animal phobias, they show activation of cingulate cortex and insula which play roles in emotion and memory and learning. -for blood injection, do not show activation in cingulate cortex and insula. instead, show Atypical activation of *occipitoparietal cortex (visual processing) and thalamus (breathing and BP)*.

Etiology of SAD

genetic factors play pretty small role. genetic factors may predispose children by increasing their level of autonomic arousal and general anxiety, anxiety to novelty. -more important is the quality of parent child relationships. insecure attachment relationships in early life predispose individuals to anxiety problems in early life predispose individuals to anxiety problems in childhood. so high levels of behavioral inhibition and insecure attachment. esp. insecure ambivalent. parents who are highly protective and controlling and model anxiety, don't encourage independent play. *WORST*: Behavioral inhibition and insecure attachment!

PTSD in Young children

have difficulty articulating their thoughts and fears and it can be difficult for clinicians to use the same diagnostic criteria for PTSD with these young kids. so there is PTSD criteria for kids 6 and younger. 1. their symptoms are expressed in terms of actions or observable behaviors--because it is difficult for preschoolers to express thoughts and feelings 2. need to show only one persistent avoidance symptom OR one negative alteration in cognition. 3. must cause distress, interfere with behavior at school or impair their relationships with parents, siblings or caregivers. so impairment in OTHERS (for adult it just for themselves). lower symptom threshold for kids.

supportive therapy for abuse and neglect

help kids cope with the feelings and memoires assoicated with their maltreatment and improve their sense of self and relationships with others. address: 1. attachment to caregivers 2. behavioral regulation 3. self perceptions. therapists primary goal is to achieve trust between child and therapist. provide safe and cosnsitent environment. teach them techniques to deal with ways to cope and deal with negative feelings.

CBT Family for abused and neglected

help parents have realistic expectations for their kids behavior. improve parent problem solving skills. *safety plan*=specific strategy for dealing with future episodes of maltreatment. learn how to identify signs abuse might occur, engage in immediate behavior to keep them safe, go to a trusted person for help. after separate sessions do joint sessions.

psychological abuse

includes 6 types of behaviors: 1. spurning-verbal and non verbal acts to reject or degrade a child. so ridiculing them for showing normal emotions. 2. terrorizing- threatening to hurt or abandon child or injure/kill a child's loved one 3. isolating-denying a child opportunities to interact with peers or adults outside the home 4. exploiting and corrupting: encouraging the child to adopt inappropriate behaviors 5. denying emotional responsiveness-ignoring the child 6. neglecting children's health and educational needs effects of domestic violence are big.

Motivational Interviewing

increase the teens desire to reduce alc consumption. realize that adolescents often have low motivation to change their drinking habits. *stages of change* as they move from stage of low motivation to higher motivation and change. Precontemplation, contemplation, action, maintenance, either relapse or termination. 5 principles of change: 1. acceptance and nonjudgemental. empathetic, warmth, genuine concern. 2. Develop discrepancies between adolescents short and long term goals and current alcohol use. 3. rolls with resistance and avoids argumentation. 4. supports any commitment to change no matter how small 5. increase self efficacy within the patient by pointing out successful change no matter how small. -so abstinence is not a primary goal of therapy. they want to adopt a *harm reduction* approach where any sort of reduction, whether choosing fewer drinks at a party is praised. can have ethical and legal implications tho. so gotta obtain parental consent prior to treatment, argue that abstinence is the ideal goal of therapy (even though low probability so any form of reduction is good), and use empirical data. DRESS: Develop a discrepancy between goals and current behavior Roll with resistance Express empathy warmth and concern Support clients efforts to change no matter how small Success should be acknowledge to build the clients self efficacy. Most efficacious for hose who have the lowest motivation to change before treatment.

Amygdo cortical neural circuit

invovles the amygdala and ventromedial PFC. The amygdala is OVERACTIVE and the ventromedial PFC is UNDERACTIVE. brain regions and connections invovled. being controlled by fear and emotions as opposed to controlling them (top up control). Dysregulation in the *amygdo-cortical neural circuit*. This circuit consists of amygdala and ventromedial prefrontal cortex (modulates fear and controls behavior). So HYPERSENSITIVITY in amygdala and UNDERACTIVITY in VPFC.

PTSD

is characterized by a set of behavioral, cognitive, emotional and physiological symptoms that emerge following exposure to a traumatic or catastrophic event. exposure to -actual or threatened death, -serious injury or sexual violence. - Must be exposed in one of the four ways: 1. directly experiencing event 2. witnessing event 3. learning that the event occurred to close family member or friend. 4. first hand exposure to aversive details about the event -needs one or more intrusion symptoms like intrusive distressing memories or dreams/flashbacks -needs persistent avoidance of stimuli -negative alterations in cognitions and mood "numbing" -marked alterations in arousal and reactivity SPECIFY IF: with dissociative symptoms=the individuals symptoms meet PTSD and the individual experiences recurrent depersonalization or realization SPECIFY IF: with delayed expression--full diagnostic criteria are not met until at least 6 months after traumatic event. so hearing about the event occuring to distant friend or stranger does not count.

maladaptive anxiety

is different from adaptive anxiety in three ways: a) intensity-maladaptive is intense and out of proportion to the threat that triggered the anxiety response. b) chronicity (duration)--always anticipate disasers. c) degree of impairment-interferes with peoples' abilities to perform tasks.

fear

is primarily a *behavioral and physiological* reaction to immediate threat, in which the person responds to immediate danger. can either be confrontational (fighting) or escape (fleeing). in the present moment!

pediatric OCD treatment study (POTS)

kids who have combined cbt and meds did best. kids with other treatments alone did about the same.

etiology ocd

kids with ocd often have first degree relatives with tics. while individuals with tics often have first degree relatives with ocd. kids with both ocd and tics have greatest impairment and anxiety. 25% of youths with ocd also meet criteria for ADHD.

external locus of control

learned helplessness!! youths with GAD underestimate their ability to cope with threatening events. often display external locus of control. they believe events and situations are largely determined by external cases (luck; fate) rather than internal causes (hard work). youths with gad often show low *self efficacy*-persons appraisal of their ability to accomplish tasks and control their surroundings. breeds rumination and worry, reduced self esteem.

Cognition and Stereotypes raised in institution

lower IQ scores, malnutrition does not predict the development of cognitive abilities but lack of cognitive and social stimulation between 0-24 months does. stereotypies=repetitive body movmeents. infants adopted out of institution before 24 months tend to do better. at risk for ADHD!

DSM-5 Conceptualization of SUDs

maladaptive pattern of substance use leading to clinically significant impairment or distress. Show at least 2 of 11 possible symptoms within a 12 month period

Etiology of PTSD

many kids are exposed to traumatic events but relatively few develop PTSD. -risk factors increase the likelihood that children will develop a particular disorder and resilience factors buffer children from the potential harmful effects of risk. so the functioning before trauma is important! proximity to the trauma is important!

Mood and anxiety problems

many phsyically and neglected kids develop mood disorders. comorbid: MDD, dythymic disorder, general feelings of hopelessness. low self esteem and low self efficacy. -PTSD. have negative views of themselves, others and the future

Social Anxiety Disorder

marked and persistent fear of social or performance situations in which scrutiny or embarrassment might occur. similar to phobia, they show immediate anxiety or panic when they encounter feared situations. some people with social anxiety disorder only experience apprehension in performance situations, they do not fear other social settings. for kids, must appear in peer settings and not just with adult interactions. -most common in formal presentations or unstructured social interactions. specify: performance only

Agoraphobia

marked anxiety about places or situations from which escape or help is not possible without considerable effort or embarrassment. 1. using public transportation 2. being in open spaces (parking lots, shopping malls) 3. being in enclosed places (stores, movie theaters) 4. standing in line or being in large crowd 5. being outside the home alone. so a woman may avoid traveling by plane because she is afraid of not being able to easily exit the plane. so she doesnt have a specific phobia of flying but she has a fear of not being able to escape. *must fear at least 2 situations. they try intensely to avoid certain situations.

meds and anxiety

medication is associated with significant reduction in symptoms but not symptom remission.

serotonin and ocd

medications that inhibit the reuptake of serotonin reduce ocd symptoms in adolescents with the disorder. so ocd symptoms are partially caused by excessively high levels of serotonin. meds may reduce ocd symptoms by decreasing the umber or sensitivity of serotonin receptors.

etiology ocd cont.

moderately heritable. shared environmental experiences like parenting and ses account for very little variance. the heritability of obsessions is slightly higher than the heritability of compulsions. neuropsychiatric disorder that is casued by abnormalities i the brain structure and functioning. a neural pathway known as *cortico striatal thalamic circuit*. forms a feedback loop and involes these. brain regions: its not inhibited in people with ocd -orbitofrontal cortex--responsible for detecting abnormalities or irregularities in teh environment and initiating a behavioral response -caudate (part of striatum) -the thalamus--behavioral responses so from orbital frontal cortex-->caudate-->thalamus in healthy people, the caudate inhibits information rom the cortex to the thalamus, thereby regulating the amount of arousal experienced by the thalamus.

cause and comorbidity

most adults with PTSD recover from disorder without treatment. 2/3 who had PTSD in adolescence no longer experience disorder in adulthood. HOWEVER, for children, PTSD persists over time!! lots of people continue to have subclinical symptoms. -depression, suicidal ideation, SUDs common comorbidity

Ethnicity

native americans show highest rates of substance use disorders followed by white and hispanic teens. African American and Asian teens show lowest rates of substance use problems. Hispanics show greatest use of hard drugs like coke and heroin.

Treatment of DSED

nearly all studies indicate that institutionalized infants who are adopted into nurturing homes prior to age 6 months do not develop significant symptoms of DSESD. so placement before 6 months is importnat!! computer programwhich fosteres the development of attentional control in typically developing young children.

medications

not considered first line of treatment. CBT plus SSRI had no difference than CBT plus placebo.

dissociative symptoms-SPECIFIER!

not needed for diagnosis of ptsd=recurrent feelings of detachment from oneself or ones surroundings -depersonalizing=detached from ones or own body or mental processes. watching themsleves in a movie. -drealization=surroundings arent real. unusual or distored world around them.

Psychological Debriefing

not so much of a treatment but a method of helping victims cope. it is usually administered by first responders or mental health professionals who arrive on the scene. single session, conducted on location in which the practitioner helps the victim describe memories of the event as well as corresponding cognitions and emotions. provides cathartic experience and facilitates coping. not really effective in reducing distress. THERE CAN BE IATROGENIC EFFECTS! increased PTSD symptoms in some cases!

kids vs. adults ocd

not unusual for kids to change obsessions and or compulsions over time. kids obsessions and compulsions are often more vague, magical or superstitious than those of adults. children may have difficulty describing their obsessions. may fear that stating their obsessions may make them come true. can be diagnosed with OCD if they show either obsessions or compulsions but in reality most kids show both. treatment of mental compulsions is more difficult than treatment of behavioral compulsions. 80% of kids with OCD have at least one other psychiatric disorder. most common co occurring are other anxiety disorder, depression, tics. OCD and tics have common genetic etiology.

Treatment for childhood anxiety

often go undetected and untreated. as many as 86% of youths with anxiety disorders never see mental health professionals. almost all efficacious psychosocial treatments for childhood anxiety disorders involve exposure therapy

Treatment of Physical abuse and Neglect

only 13% recieve treatment. *supportive therapy* is most commonly used.

pharmacodynamic tolerance

over sustained periods of time, sensitivity of neuroreceptors that respond to alc decrease. so exhibit same sedating effects of alc due to this decrease in sensitivity to GABA. frequent drinkers require more alc to achieve state of euphoria. so because of this decrease in sensitivity, abrupt discontinuation of alc can produce withdrawal symptoms in chronic users. decreased GABA and dopamine sensitivity. dopamine=excitatory. so decreased gaba sensitivity=anxiety and stuff. decreased dopamine is more the lack of energy. sensitivity=feelings of anxiety, excitability, irritability, restlessness and excessive motor activity. less common in adolescence.

Panic disorder and agoraphobia in children and adolescents

panic attacks are relatively common among youths. as many as 18% of adolescents have had at least one full blown panic attack. 60% have sub threshold symptoms. equally common in boys and girls but may be more severe in girls. panic disorder is relatively rare in kids! relatively uncommon in adolescents. onset for panic disorder is around 15 an 19. most cases of panic disorder go undetected in children and adolescents. usually interpret panic symptoms as medical problems. panic disorder is rarely seen in prepubescent children. perhaps they lack the capacity for metacognition-the ability to think about their own thoughts and feelings. people with panic disorder often have co occuring agoraphobia. most commonly occuring disorder iwth panic is GAD. Panic often precedes mood and substance use disorders.

generalization and relapse prevention

parents play important rle in this part of treatment. therapist teaches parents how to coach their kids thorugh EX/RP taks and asks parents and kids to continue confronting feared stimuli outside the therapy setting.

expectancy theory of panic

people with high anxiety sensitivity are unusually sensitive to the physiological symptoms of anxious arousal. pay special attention to heart increase and shallowness of breath. -they personalize negative events (blame themselves) -catastrophic thinking--when distressed they anticipate the worst possible outcomes. -self fulfilling profecy

two factor theory of anxiety

phobias DEVELP through classical conditioning and other forms of social learning but they are MAINTAINED through operant conditioning, mainly negative reinforcement. so avoiding the stimulus has reduction of anxiety--negative reinforcement.

Behavior problems

physically abused kids are more likely to use both proactive and reactive aggression. -*learning theory*=phsycially abused children may model the hostile and aggressive behavior of caregivers. -Social information processing theory=children solve social problems by engaging in a series of cognitive steps: 1. taking in and interpreting information, 2. generating and evaluating a number of ways to respond 3. select and implement the best plan. so physically abused kids show difficulty with all three of these. often interpret oters behaviors as hostile and aggressive even if it isnt. neglect-->few friends-->antisocial

Worry

primarily a *cognitive* response to threat, in which the person considers and prepares for future danger or misfortune. Worry about next week's exam, or an upcoming job interview. So chronic state of psychological distress. Thoughts and statements about the future. future worries.

Treatment for RAD

prognosis for RAD is good if kids are provided sensitive and responsive care by foster or adoptive parents. home placement early in development is important. before age 10 months!! mothers and babies showed reciprocity and influenced each others behaviors. Attachment And Biobehavioral Catch up (ABC)-parents taught to meet infants need, respect autonomy and self direction, overcome barriers to caregiving. efficacious for promoting secure attachments but no studies on kids with RAD.

Psychosocial Treatments

psychotherapy is treatment of choice for teens and suds. do better when they participate in therapy. kids with extensive suds, history of cd and anxiety and depression are less responsive to treatment. a lot of kids dont have access to this treatment tho.

eye movement desensitization

ptsd treatment in adults. generate mental image of traumatic experience and then follow the finger movements of the therapist. not sure if its efficacious in kids.

Panic Disorder

rare in children.linked to high levels of general physiological arousal, unusual sensitivity tot threats or danger, tendency to engage in catastrophic thinking. panic disorder is a serious condition characterized by the presence of recurrent, unexpected panic attacks that cause the person significant distress or impairment. panic attack: is an acute and intense episode of psychological distress and autonomic arousal. -cognitive symptoms (im going crazy) -emotional symtoms (unreality/detachment) -somatic symptoms (chest pain, heart palpitations, dizziness). if a panic attacks dont not cause impairment or distress its not panic disorder. needs to be UNEXPECTED.

obessions

recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted. thoughts about contamination, repeated doubts, need for order or symmetry, aggressive or horrific impulses (thoughts about swearing in church, sexual imagery). most people try to ignore the obsession but this usually causes an increase in anxiety

Reticular Fomration-alc

responsible for alerting us to important information in the environment and initiating attention and arousal. Increase NE in this area. so this is why we have increased alertness, socialbility and talkativeness after a coulple drinks.

Reward Pathway (DOPAMINERGIC MESOLIMBIC PATHWAY)-1st part of the biphaisc effect.

reward pathway and extends from the ventral tegmental area of the mid brain to the nucleus accumbens, amygdala and hippocampus located in the limbic system. Responds primarily to DOPAMINE (pleasure, positive affect and increased motor activity). So alc. stimulates dopaminergic neurons in VTA then the VTA increases dope levels in nearby brain area, *nucleus accumbens*, producing subjective feelings of euphoria (first phase of biphasic, + reinforcement). increases neuronal activity in the amygdala and hippocampus which accounts for highly emotional memories associated with alc and the cravings. -also increase the release of endogenous opioids. affects GABA=is enhanced! produces decrease in neuronal activity which is partially responsible for many of the sedating effects of alcohol like relaxation, cognitive sluggishness.

Disinhibited Social Engagement Disorder (DSED)

show 2 indiscriminate behaviors, specify severity, need to have developmental age of 9 mos. pattern of behavior that involves culturally and developmentally inappropriate overly familiar behavior with strangers. 6 or 7 months we se wariness of strangers in typical kids. but kids with dsed dont. -only diagnosed if the person has history of severe neglect or social emotional deprivation. can be from kids in institutions or who have disruptions in their caregiving over first year of life. relationships are often one sided and superficial. have trouble bonding with biological or adoptive parents after leaving their institutions, "indiscriminately friendly children"

older children and PTSD

show closer correspondence between PTSD symptoms and trauma. more likely to report more intrusive thoughts and nightmares associated with the trauma and sometimes show omen formation.

RAD

specify severe, developmental age of 9 mos. before 5 years. rare disorder seem almost exclusively in infants and young children who experience extreme deprivation. distrubed or developmentally inappropriate attachment beahviors. dont seek comfort from caregivers when distressed, instead they are inhibited and emotionally withdrawn from caregivers. "emotionally absent". show very little positive affect. Caused by pathogenic care such as severe physical or emotional neglect, frequent and repeated changes in primary caregivers, like frequent relocations to different foster homes. most often seen in international adoptees who spent their fist 12-24 months of life in orphanages.

Etiology of Social anxiety disorder

strong heritability!! genetic factors seem to underlie the childs risk. kids often inherit a temperamental predisposition toward social anxiety that can develop into social anxiety disorder later in life: HIGH behavioral inhibition (tendency to withdraw when confronted with unfamiliar situations. also classical and operant conditioning! 50% of diagnosed youth report humiliating or embarrassing event triggering disorder. parents with social anxiety disorder increase risk. more controlling!, intrude on their kids bheavior dont allow them to make decisions on their own. overprotective too!! high levels of hostile and critical behavior! teach their kids to be anxious! avoiding emotionally charged discussions! remember that this is bidirectional.

Withdrawal

substance specific problematic behavioral change that is due to the cessation of or reduction in heavy and prolonged substance use. ie pacing, anxiety, unpleasant dreams, rapid heart rate. always problematic!

Substance-Induced Disorders

substance specific syndromes caused by either the ingestion of alc. or other drugs or their withdrawal. DSM has 3 substance induced disorders: 1. Substance Intoxication 2. Substance Withdrawal 3. Substance-Induced Mental Disorder

Relapse

teens more likely to relapse because of exposure to substance using peers pressure and encouragement from friends and desire to enhance mood. In contrast, adults relapse often when derepressed, anxious or distressed.

Cognitive Appraisal Theory

the way people feela bout situations depends on their evaluatons of those situations. kids who expiernce trauma as persoanlly relevant show more issues than those who cognitively distance themselves. -coping=thoughts feelings and actions that protect oneself from psycholigical damage following a stressful event. -problem focused coping vs. escape or avoidance coping. problem focused is better!!

Adolescent substance use vs. adult

these symptoms are more likely in adolescents than adults: -tolerance, time spent on obtaining substances and substance use in hazardous situations. -tolerance tends to occur much faster for young kids than adults who have been drinking for a while. -Time spent on obtaining substances: adults who spend a lot of time might have a real big problem but kids who spend a lot of time might not because its hard for them to get alc in the first place so kinda have to spend more time. -alc use is more episodic, drink in binges -greater number of substances simultaneously used -show comorbid behavior problems-kids show more disruptive and antisocial behaviors whereas adults show more anxiety and mood problems with their suds. -more likely to "out grow" their substance use problems. --great changes in psychological and psychosocial changes

compulsions

to reduce the feelings of distress, most people engage in compulsions. these are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. washing, cleaning, counting, checking, repeating, arranging, and ordering. many realize that these images are a product of their own mind and will probably not come true.

Acute tolerance

tolerance that happens within one episode. greatest effects of alc after only a few drinks with diminishing effects after each successive drink.

exposure and response prevention (ex/rp)

using info gathered during interview, the child and clinican develop a heirarchy of feared stimuli. over several weeks, the child eposes himself to each of the feared stimuli gradually progressing up the hierarchy. at the same time, the child must not engage in the rituals he feels compelled to do after confronting the feared stimuli. wrprls through the prinicple of extinction.

Social Anxiety in childhood and adolescence

usually emerges in late childhood or early adolescence. *not usually diagnosed before age 10.*. most common fears: formal presentations and unstructured social interactions. usually avoid situations that elicit anxiety, so this is negatively reinforced.

Child Maltreatment definition

varies by state and profession. "physical or mental injury, sexual abuse, exploitation, negligent treatment or maltreatment of a child under the age of 18 by a person who is responsible for the childs welfare. DSM 5 Recognizes: 1. physical abuse 2. sexual abuse 3. psychosocial abuse 4. neglect. Multifinality!

modeling and phobias

what another person confront the stimulus. *participant modeling* the therapist first models the behavior for the child and then helps the child perform the behavior himself.

cognitive avoidance theory

worrying helps people avoid emotionally and physically arousing mental images. worry allows people to replace these emotion laden images of imminent danger with more abstract, analytical thoughts about future misfortune, worry, therefore is a form of avoidance and is negatively reinforcing. chronic worriers use more strategies like distraction or thought suppression to avoid dealing with future problems. low level worriers tend to use more active problem solving strategies that help them address problems directly like studying for an exam. so number of avoidance strategies used by children predicted the severity of their worrying. kids with GAD worry to avoid thinking about problems, not to solve them. they simply ruminate about the negative event. instead of saying wow this exam is gonna be hard i gotta study. they say wow this exam is gonna be hard what if i fail what will my mom say?

Research Unit on Pediatric Psychopharmacology Anxiety Study

youths who got SSRIs had better SAD, social phobia and GAD than controls.

pediactirc ocd treatment study II (POTS II)

youths who received medication plus actual cbt were significantly more likely to succeed than youths who received medication alone or medication plus instructionss about cbt.

cognitive distortions

youths with GAD may show cognitive distortions that cause them to worry. catastrophizing overgeneralizing-a single adverse event will predict future misfortune. personalizing