Psych 476 - Unit 3 Exam

characteristics of children with GAD

"little adults" tend to worry about adult things perfectionistic excessive reassurance seeking - asking parents to tell them everything is going to be okay, reinforces the anxiety eager to please and highly conforming to rules harbor feelings of self doubt and criticism

characteristics of Attachment & Biobehavioral Catch-up (ABC): A Treatment for RAD

-10, 1 hour sessions -Foster parents are taught the importance or warm and nurturing parenting -Parents are encouraged to give infants greater autonomy & to be sensitive and responsive to their needs -Therapists provide coaching and support

what 3 disorders need to be ruled out before diagnosing DMDD

-ADHD -Oppositional Defiant Disorder -Bipolar Disorder

what symptoms need to be shown in a major depressive episode

-At least 5 out of 9 symptoms -At least one of the symptoms must be depressed mood or diminished interest or pleasure in most activities

PTSD in older children

-Close correspondence between PTSD symptoms & the trauma they experienced -Intrusive thoughts & nightmares are common -Omen formation

Separation Anxiety comorbidity in older children (adolescents)

-Generalized Anxiety Disorder -Social Anxiety Disorder

what 3 factors about personality are associated with increased risk of Disruptive Mood Dysregulation Disorder

-May selectively attend to negative social cues that predispose them to anger -Often show deficits in recognizing and interpreting others' emotions -Problems in monitoring and regulating their own emotions and behavior, especially negative emotions -make more errors in labeling emotions than children without this diagnosis (especially fear, sadness, or anger)

5 components of trauma-focused CBT

-Parent education -Relaxation strategies -Exposure sessions (imagined or in vivo) -Trauma narrative -Changing negative cognitions -identify physiological and cognitive responses to trauma -planning for the future

symptoms associated when depressed for persistent depressive disorder

-Poor appetite or overeating -Insomnia or hypersomnia -Low energy or fatigue -Low self-esteem -Poor concentration or difficulty making decisions -Feelings of hopelessness

characteristics of depressive disorders

-Predominately depressed or irritable mood -Lack of interest in people and activities -Problems meeting the demands of every day life -don't show the same depressed mood that we see in adults seen as hyperactivity, irritability, impulsivity

what are the two types of coping strategies that can be used by a children exposed to trauma

-Problem-focused coping -Escape/avoidance coping

PTSD in adolescents

-Similar to adults, but usually do not experience flashbacks -Likely to experience recurrent intrusive thoughts, images, & dreams

Separation Anxiety comorbidity in younger children (6-10 years)

-Specific Phobia -ADHD -Oppositional Defiant Disorder

when is Parent Training (PCIT) typically used

-intervention to improve the relationship between parents and children when abuse has occur; parents love their children, have own mental health problems, substance abuse problems, or abused themselves so lack of good parenting skills -goal is to reestablish these relationships and develop those good parenting skills

FDAs clinical review of antidepressant medications

-look at the impact of these medications before or after they came out -found a higher rate of suicidal thinking in the group that was taking compared to the group that was not taking medication -issued a public warning and required this black box warning -treatment group 4% of adolescents reported an increase in suicidal thoughts compared to 2% taking placebo -still prescribed but a bit of controversy

how can child abuse be costly society

-medical and mental health care for children -out of home placement - foster care is very expensive -prosecution of offenders -lower academic achievement and job attainment for victims (related to long term negative outcomes)

characteristics of operant conditioning associated with specific phobias

-reinforces phobias -reinforced by the comfort given by a caregiver as a result of a phobic response -avoiding the phobic situation reinforces us because nothing bad happens

5 characteristics of Excoriation Disorder

-skin-picking -person picks at their skin or scabs on their skin -long periods of time, sort of out of it when they engage in this behavior causing significant damage - experience a lot of shame - highly comorbid with OCD

characteristics of the HPA axis

-system regulates stress response and hormone -when you experience something stressful your body produces cortisol through this system -hypothalamus notices and triggers the endocrine system to release cortisol -in a normal brain turns off this system -in children who experience trauma we tend to see overactivity in this brain axis (tend to have high blood pressure, hypervigilant, prone to startle response) -over time (chronic) we tend to see the body overcompensate and we see low levels of cortisol

characteristics of observational learning associated with specific phobias

-true especially for a fear of snakes -we hear others talk about their fear even if we did not have a bad experience with a snake -modeling, watch other people respond in a phobic way which is another way we can develop phobias

characteristics of classical conditioning associated with specific phobias

-underlies many cases of specific phobias -Little Albert -common reason why we see phobias develop and sometimes do not know when the conditioning occurred

purpose of mood ratings

-used to gather a baseline over a week about how many fun things they are doing and their mood before starting treatment -used for goal setting to help increase the fun activities they do during the week (behavioral activation) -lastly used to monitor their own progress and outcomes overtime -look for connection between the number of fun activities and your mood for each day (often seen a connection)

CBT for OCD

-utilizes exposure and an important component is ritual prevention -experience the trigger for their obsession and then they engage in compulsion - typical OCD experience -expose individual's to their triggers again using fear hierarchy but will not allow them to engage in the compulsion -gradually habituate the fear

how many suicide attempts result in death

1 in every 100

how many survivors will suffer from long-term mental health issues if distress is disregarded

1 out of 4

what percent of children and adolescents experience OCD

1-2%

what percent of children and adolescence develop PTSD

1-5% of children and adolescents

9 symptoms associated with a major depressive disorder

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.) 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation). 3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.) 4. Insomnia or hypersomnia nearly every day. 5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

3 symptoms associated with criteria A of insomnia disorder

1. Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.) 2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.) 3. Early-morning awakening with inability to return to sleep.

7 symptoms associated with a manic episode

1. Inflated self-esteem or grandiosity. 2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). 3. More talkative than usual or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity). hyper-sexuality 7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

7 symptoms associated with hypomanic episode

1. Inflated self-esteem or grandiosity. 2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). 3. More talkative than usual or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity). hyper-sexuality 7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

3 symptoms associated with criterion B of the Reactive Attachment Disorder: Diagnostic Criteria

1. Minimal social and emotional responsiveness to others. 2. Limited positive affect. 3. Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.

4 symptoms associated with criterion A of the Disinhibited Social Engagement Disorder: Diagnostic Criteria

1. Reduced or absent reticence in approaching and interacting with unfamiliar adults. 2. Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries). 3. Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings. 4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.

3 symptoms associated with criterion C of the Disinhibited Social Engagement Disorder: Diagnostic Criteria

1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. 2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care). 3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).

3 symptoms associated with criterion C of the Reactive Attachment Disorder: Diagnostic Criteria

1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. 2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care). 3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).

2 symptoms associated with criterion A of the Reactive Attachment Disorder: Diagnostic Criteria

1. The child rarely or minimally seeks comfort when distressed. 2. The child rarely or minimally responds to comfort when distressed.

2 avoidance symptoms - criteria C

1. avoidance of or efforts to avoid distressing memories thoughts, or feelings about or closely associated with the traumatic event(s) substance abuse 2. avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)

4 steps to the development of constipation

1. avoidance or fear of the toilet: child refuses to go because of painful bowel movements or psychosocial stress 2. stool is retained and rectal wall is stretched: sensory feedback is reduced and child has less urge to go 3. constipation & impaction: water is absorbed into body and stool becomes hard 4. overflow: diarrhoea-like feces builds up behind hard fecal mass and seesp out; impacted mass remains

what 3 areas experience changes when in the presence of the phobic thing

1. cognition 2. physiology 3. behavior

what are the 4 exposure symptoms associated with PTSD - criteria A

1. directly experiencing the traumatic event(s) 2. witnessing in person the event(s) as it occurred to others 3. learning that the traumatic event(s) occurred to a close family or friend, the event(s) most have been violent or accidental (died in car accident or shooting) 4. experiencing repeated or extreme exposure to aversive details of the traumatic event (first responders collecting human remains; police officers repeatedly exposed to details of child abuse)

Sleep-onset type characteristics

1. falling asleep is an extended process that requires special conditions to be present 2. sleep-onset associations are highly problematic or demanding 3. in the absence of the associated conditions, sleep onset is significantly delayed or sleep is otherwise disrupted 4. nighttime awakenings require caregiver intervention for the child to return to sleep or sleep conditions to be present

3 components of the triple vulnerability model that interact together to cause anxiety

1. genetic and biological risk factors that are highly heritable - do not affect behavior directly but might influence structures and functions of the brain 2. early social-emotional experiences that give children a sense of vulnerability or lack of control (parenting factors, family stress, etc.) 3. specific environmental experiences that can determine the nature of the child's fears

3 characteristics of a sleep diary

1. get a sense of what is going on with a child's sleep very quickly 2. assess sleep schedule 3. continue to use to track treatment progress

what are the two main goals of the treatment for RAD

1. getting children out of the unsafe and unstable environments and into environments that they can build attachments 2. help build attachment using therapist coaching and support

what are the 3 main symptoms for children

1. grandiosity 2. decreased need for sleep 3. high-risk sexual activity

what are the characteristics of what children with GAD worry about

1. greater number of worries at the same time 2. little things tend to become bigger 3. pervasive worries and a hard time controlling them

2 characteristic features of selective mutism

1. have a set of rules of who they can and cannot speak to, unique for each individual 2. consistent failure to speak in certain social situations in which there is an exception for speaking

Eye Movement Desensitization and Reprocessing (EMDR) Characteristics

1. have the patient hold an image of the trauma in their mind as they follow the therapists fingers that are moving back and forth 2. does not seem to make a lot of sense but it is a well-established treatment for adults with PTSD 3. systematic desensitization component to this treatment is holding the image in your mind serves as a type of exposure 4. eye movement serves as a type relaxation strategy

steps of the HPA axis

1. hypothalamus produces corticotropin releasing hormone 2. travels to the anterior pituitary where it is converted into adrenocorticotropic hormone 3. travels to the adrenal cortex where it is converted into cortisol

Psychosocial Treatment: child group characteristics

1. icebreakers; identifying goals for a personal "fix it" kit 2. recognizing emotions in self and others 3. anger 1: what does anger look like? 4. rating the intensity of my anger 5. anger 2: coping to get calm 6. deep breathing relaxation, guided imagery 7. anger 3: how to stay in control 8. strategies to cope with teasing 9. perspective taking, considering other people and consequences before acting 10. being a good listener and communicate 11. problem-solving skills 12. how to recognize and cope with depression 13. putting it together and awards ceremony

7 negative alteration in cognition symptoms associated with PTSD - criteria D

1. inability to remember an important aspect of the traumatic event(s) 2. persistent and exaggerated negative beliefs or expectations about oneself others or the world 3. persistent distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others 4. persistent negative emotional state (fear, horror, anger, guilt, or shame) 5. markedly diminished interest or participation in significant activities 6. feelings of detachment or estrangement from others 7. persistent inability to experience positive emotions (inability to experience happiness, satisfaction, or loving feelings)

Suicide Prevention in Schools

1. increased effort in schools 2. 2nd leading of cause among 10-25 year olds 3. approx. one in six adolescents reported serious suicidal ideation 4. sources of strength

Psychosocial Treatment: parent group

1. info about DMDD; intro to contingency management 2. attending to children's positive behavior 3. identifying anger in your child; using a daily report card to monitor child behavior 4. helping children cope with anger, the importance of consistent "house rules" 5. responding to problem behaviors ignoring and using time out 6. anger triggers and negative family cycles; negative parent-child interactions 7. improving parent-child communication 8. problem-solving skills 9. coping with depression in parents and kids 10. review and graduation ceremony

3 characteristics of Tic Disorder

1. involve involuntary motor movements or vocalizations 2. some are simple and some get more complex (eyes move to the side and move their shoulders in a certain way) 3. when a see motor and vocal ties combine thats when we diagnose Turrets Syndrome

6 symptoms of arousal and reactivity associated with PTSD - criteria E

1. irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression towards people or objects 2. reckless or self-destructive behavior 3. hyper-vigilance 4. exaggerated startle response 5. problems with concentration 6. sleep disturbance

characteristics of sources of strength

1. is a suicide prevention program for people experiencing suicidal ideations or everyday things 2. peer training - break the stigma 3. not likely to talk to adults, so talking to their peers were more helpful 4. working to understand when someone might be experiencing these feelings and try to help them

Major Depressive Disorder vs. Persistent Depressive Disorder: Onset

1. major depressive disorder has a much more rapid onset and can often proceeded by specific identifiable events 2. persistent depressive disorder builds gradually overtime

gender difference for symptoms of bipolar disorder

1. men tend to have early onset of symptoms, and more frequent manic episodes 2. women tend to demonstrate a higher frequency of psychotic features (hearing voices or experiencing paranoia) 3. boys more likely to have comorbid ADHD; girls more likely to have comorbid anxiety disorders

characteristics of phase delay

1. move forward around the clock until a point where they are sleeping through the day and you reset their circadian rhythm 2. parents need to be really involved to make sure they are going to bed and waking up at the right time

how can bipolar disorder be ruled out?

1. need a history to understand how the DMDD developed 2. in the 1990s began to see children and adolescents with these behaviors (hyperactivity, irritability, severe temper outbursts) 3. ADHD and ODD did not really capture these behaviors properly and the severity of the irritability, anger or tantrums 4. clinicians began to hypothesize that this was a childhood presentation of bipolar disorder (pediatric bipolar disorder) 5. demonstrating these behaviors they are going through rapid cycling (has not been held up in research) 6. can be diagnosed with this disorder but they would follow the typical diagnostic criteria

characteristics of parent-child interactions that contribute to social anxiety disorder

1. parents of children with social anxiety experience social anxiety themselves and model those behaviors 2. tend to be over controlling, communicate with their child that challenges may be too big and unable to cope with those challenges over protective and critical 3. avoid emotional discussions and not developing skills to deal with these emotional situations

what are the worry domains and what percent of children with and without GAD worry about these topics

1. perfectionism - w/ GAD ~35% - w/o GAD ~30% 2. health of self - w/ GAD ~40% - w/o GAD ~30% 3. school - w/ GAD ~40% - w/o GAD ~25% 4. relationships - w/ GAD ~45% - w/o GAD ~25% 5. world events - w/ GAD ~45% - w/o GAD ~35% 6. little things - w/ GAD ~50% - w/o GAD ~30% 7. family matters - w/ GAD ~50% - w/o GAD ~20% 8. general performance - w/ GAD ~50% - w/o GAD ~20% 9. health of others - w/ GAD ~55% - w/o GAD ~45%

6 factors involved in the etiology of PTSD

1. pre-trauma functioning 2. proximity to trauma 3. brain & endocrine functioning 4. cognitive appraisal theory 5. coping 6. family functioning

Typical situations feared by children with social phobia: %

1. reading aloud in front of the class 71% 2. musical or athletic performance 61% 3. join in on a conversation 59% 4. speaking to adult 59% 5. starting a conversation 58% 6. writing on the blackboard 51% 7. ordering food in a restaurant 50% 8. attending dances or activity nights 50% 9. taking tests 48% 10. parties 47% 11. answering a question in class 46% 12. working or playing with other children 45% 13. asking a teacher for help 44% 14. physical education class 37% 15. group or team meetings 36% 16. having a picture taken 32% 17. using school or public bathrooms 24% 18. eating in the school cafeteria 23% 19. walking in the school hallway 16% 20. answering or talking on the phone 13% 21. eating in front of others 10%

what are obsessions defined by (thoughts)

1. recurrent and persistent thoughts, urges, or images that are experienced at some time during the disturbance as intrusive and unwanted and that in most individuals caused marked anxiety or distress 2. the individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (by performing a compulsion)

8 symptoms that can be associated with diagnostic criteria A

1. recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures 2. persistent and excessive worry about experiencing and untoward event (getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure 3. persistent and excessive worry about losing major attachment figures or about possible harm to them such as illness injuries disasters or death 4. persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation 5. persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings 6. persistent reluctance or refusal to sleep away from home or go to sleep without being near a major attachment figure 7. repeated nightmares involving the theme of separation 8. repeated complaints of physical symptoms (headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.

5 intrusive symptoms associated with PTSD - criteria B

1. recurrent, involuntary, and intrusive distressing memories of traumatic event(s). in children older than 6 years repetitive play may occur in themes or aspects of the traumatic events and [sic] expressed 2. recurrent or distressing dreams in which the context and/or affect of the dream are related to the traumatic event(s). in children there might be frightening dreams without recognizable content 3. dissociative reactions in which the individual feels or acts as if the traumatic event(s) were recurring. in children trauma-specific reenactment may occur in play (flashbacks not common) 4. intense or prolonger psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s) 5. marked psychological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)

characteristics of encopresis

1. related to constipation 2. not intentional and should not be punished 3. can't tell when they are happening and unable to stop them

what are compulsion defined by (behaviors)

1. repetitive behaviors (hand washing, ordering, or checking) or mental acts (praying, counting, repeating, words silently) that the individual feels driven to perform in response to an an obsession or according to rules that must be applied rigidly 2. the behaviors or mental acts are dimmed at preventing or reducing anxiety or distress of preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with that they are designed to neutralize or prevent, or are clearly excessive

4 characteristics of Trichotillomania

1. repetitive hair-pulling typically on their head 2. report being in a trance-like state when they engage in this behavior 3. a lot of shame and guilt lead to depression 4. highly related to OCD

how can ADHD be ruled out?

1. show behaviors similar to hyperactivity or impulsivity 2. children with ADHD don't experience that persistent irritable and angry mood 3. children with ADHD we do not see those verbal rages or physical aggression toward property 4. easiest to rule out

Major Depressive Disorder vs. Persistent Depressive Disorder: duration

1. symptoms of major depressive disorder have to last at least 2 weeks (avg. epsiode lasts about a month) 2. symptoms of persistent depressive disorder have to be seen for at least a year

Major Depressive Disorder vs. Persistent Depressive Disorder: Severity of Symptoms

1. symptoms of persistent depressive disorder are not as severe 2. no suicidal ideation or suicidal behaviors and anhedonia for persistent depressive disorders 3. presentation of symptoms is less severe

3 characteristics of limit-setting type

1. the individual has difficulty initiating or maintaining sleep 2. the individual stalls or refuses to go to bed at an appropriate time or refuses to return to bed following a nighttime awakening 3. the caregiver demonstrates insufficient or inappropriate limit setting to establish appropriate sleeping behavior in the child

5 steps used in supportive therapy

1. therapist listens carefully and gives you an opportunity to express you feelings and thoughts and supports your coping strategies 2. during your sessions your therapist may provide reassurance and guidance 3. you use your problem-solving skills to gain a better understanding of your situation and to consider alternative choices and strategies 4. your self-esteem and resilience are reinforced 5. "deeper" probing and exploration of your life is considered unnecessary (or too difficult) at this time

how can oppositional defiant disorder be ruled out?

1. very challenging to rule out, really challenging to differentiate 2. similar criteria for both 3. highly comorbid diagnosis 4. tend to differ in the duration and severity of temper outbursts (DMDD is more severe) 5. you cannot be diagnosed with both of these disorders, so if you meet the criteria for both you should be given the diagnosis of DMDD

what fraction of children exposed to trauma develop PTSD

1/3

what percent of school-aged children stall or resist bedtime

10%

amount of sleep needed for 6-12 years

10-11 hours; sleep latency = 20 min

what percent of children with OCD have at least one parent with OCD

10-25%

amount of sleep needed for 3-5 years

11-12 hours

what percent of children between the ages of 0 to 17 have experienced at least one form of maltreatment according to the National Survey of Children's Exposure to Violence (2015)

12.1%

what percent of children and adolescents will develop an anxiety disorder before reaching adulthood

15-20%

how many youths are reported yearly to child protective services for suspected maltreatment

2.6 million

what percent of enuresis cases show reduced secretion of arginine vasopressin (AVP)

20%

what year did NSSI and DSH spike

2007

what percent of infants & toddlers have difficulty falling asleep independently

25%

what percent of children involved in a fire or serious auto accident develop PTSD

25-30%

what percent of parents report at least occasional sleep problems for their children

25-50%

what percent of adolescents at any given time; up to what percent of adolescents may experience MDD at some time during adolescence

3-7%, up to 20%

what percent of cases seen by prof are toileting problems

30%

what percent of children develop a sleep disorder at some point during childhood

30%

heritability of anxiety disordes

30-40%

how many children in LA are in the child welfare system? how many need more dedicated therapeutic care? how many families have the expert training and coaching for this treatment?

35000, 300, and 100 families

what percent of children between the ages 8 and 11 experience enuresis

4-5%

what percent of children who are refugees from war-torn countries, victims of chronic child abuse, or children who are repeatedly exposed to domestic violence develop PTSD

40-60%

what percent of youths with OCD continue to meet diagnostic criteria 5 years later, very persistent

41%

how many americans have bipolar disorder

5.7 million

How many suicide attempts are made each year?

500,000

what percent of children will stop bedwetting in 8-14 weeks (2-3 months)

59-78%

how long do scheduled sits take to treat encopresis

6 months, because you have to treat constipation before anything else

how many weeks do you begin success in treatment using urine alarm

6 weeks or so depending on consistency of use

what percent of 3rd graders self-harm

7.6%

what percent of napping stops by age 5

75%

what percent of enuresis cases are primary

75-80%

what percent of children experience enuresis when both parents experienced enuresis? one parent

77%, drops to 44%

without treatment what is the average duration of selective mutism

8 years

what percent of children with OCD will experience at least one other psychiatric disorder

80%

amount of sleep needed for 12-18 years

9-11 hours

about what percent of children and adolescents may experience OCD but are not receiving treatment

90%

how many of those cases are substantiated (prove child abuse or neglect)

900,000

Social Anxiety: Etiology

> Heritability estimates around 50% - Temperament and behavioral inhibition > Classical conditioning and negative reinforcement > Parent-child interactions

what criteria represent a major depressive episode

A-C

Reactive Attachment Disorder: Diagnostic Criteria

A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following: B. A persistent social and emotional disturbance characterized by at least two of the following: C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following: D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C). E. The criteria are not met for autism spectrum disorder. F. The disturbance is evident before age 5 years. G. The child has a developmental age of at least 9 months.

what is a manic episode defined by

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior: C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition.

hypomanic episode is defined by what

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to a significant degree: C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. D. The disturbance in mood and the change in functioning are observable by others. E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic. F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition .

Disinhibited Social Engagement Disorder: Diagnostic Criteria

A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following: B. The behaviors in Criterion A are not limited to impulsivity (as in attention-deficit/hyperactivity disorder) but include socially disinhibited behavior. C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following: D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C). E. The child has a developmental age of at least 9 months.

Insomnia Disorder: Diagnostic Criteria

A. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms: B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning. C. The sleep difficulty occurs at least 3 nights per week. D. The sleep difficulty is present for at least 3 months. E. The sleep difficulty occurs despite adequate opportunity for sleep. F. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia). G. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.

PTSD: Diagnostic Criteria

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways B. presence of one or more of the following intrusion symptoms associated with the traumatic event(s) beginning after the traumatic event(s) occurred C. persistent avoidance of stimuli associated with traumatic event(s), beginning after the traumatic event(s) occurred as evidenced by one of both of the following D. negative alterations in cognitions and mood associated with the traumatic event(s) occurred, as evidenced by two (or more) of the following E. marked alterations in arousal and reactivity associated with the traumatic events, beginning or worsening after the traumatic event(s) occurred as evidenced by two (or more) of the following F. Duration of disturbance is more than 1 month G. the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning H. the disturbance is not attributable to the psychological effects of substance or another medical condition

Major Depressive Disorder: Diagnostic Criteria

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The episode is not attributable to the physiological effects of a substance or another medical condition. D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. E. There has never been a manic episode or a hypomanic episode.

Specific Phobia Diagnostic Criteria

A. Marked fear or anxiety about a specific object or situation (flying, heights, animals, receiving an injection, seeing blood) - in children could be expressed by crying, tantrums, freezing or clinging B. Phobic object or situation almost always provokes immediate fear or anxiety C. Phobic object or situation is actively avoided or endured with intense fear or anxiety. D. Fear or anxiety is out of proportion to the actual danger posed by the specific object or situation, and to a socio-cultural context. E. Fear, anxiety, or avoidance is persistent; typically lasting 6 months or more. F. Fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. G. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (OCD); reminders of traumatic events (PTSD); separation from home or attachment figures (Separation anxiety disorder); or social situations (Social Anxiety Disorder)

Disruptive Mood Dysregulation Disorder: Diagnostic Criteria

A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. B. The temper outbursts are inconsistent with developmental level. C. The temper outbursts occur, on average, three or more times per week. D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers). E. Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D. F. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these. G. The diagnosis should not be made for the first time before age 6 years or after age 18 years. H. By history or observation, the age at onset of Criteria A-E is before 10 years. I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met. J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]). K. The symptoms are not attributable to the physiological effects of a substance or another medical or neurological condition.

Behavioral Insomnia of Childhood: Diagnostic Criteria

A. a child's symptoms meet the criteria for insomnia based upon reports of parents or other adult caregivers B. the child shows a pattern consistent with either the sleep-onset association type or limit-setting type of insomnia C. the sleep disturbance is not better explained by another sleep disorder, medical or neurological disorder, mental disorder, or medication use

Bipolar 1: Diagnostic Criteria

A. criteria have been met for at least one manic episode B. the occurrence of the manic episode is not better explained by schizophrenia or another psychotic disorder

Separation Anxiety Disorder Diagnostic Criteria

A. developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least 3 of the following. B. the fear, anxiety, or avoidance is persistent lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults C. the disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning D. the disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in ASD, refusal to go outside without a trusted companion in Agoraphobia, worries about ill health or other harm befalling significant others in generalized anxiety disorder

Social Anxiety Disorder Diagnostic Criteria

A. marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by other social interactions, being observed or performing in front of others. In children, it needs to occur in peer situations and not just during interactions with adults B. the individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated C. social situations almost always provoke fear or anxiety. in children expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations D. the social situations are avoided or endured with intense fear or anxiety E. the fear or anxiety is out of proportion to the actual threat posed by the social situation and to the socio-cultural context F. the fear, anxiety, or avoidance typically 6 months or longer G. the fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning H. the fear, anxiety, or avoidance is not attributable to the physiological effects of a substance or another medical condition I. the fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder or ASD J. If another medical condition is present the fear anxiety or avoidance is clearly unrelated or is excessive

OCD: Diagnostic Criteria

A. the presence of obsessions, compulsions, or both B. the obsessions or compulsions are time consuming (take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning C. to obsessive-compulsive symptoms are not attributable to the psychological effects of a substance or another medical condition D. the disturbance is not better explained by the symptoms of another mental disorder

what percent of the population is affected by bipolar

About 1% of the population

at any point in time what percent of youths have at least one anxiety disorder

Approximately 5%

why should you ask questions when concerned and see if you can get them to help

Asking about suicide DOES NOT increase suicidal ideation

what third variable could cause NSSI lead to suicide

Borderline personality disorder or other mental health disorders

how does parent-child attachment involved in the development of depressive disorders

Children with insecure attachment often have low self-esteem, derive self-esteem from others rather than their own sense of self worth

what happens to the prevalence of enuresis with age

Decreasing prevalence

•synthetic version of the AVP hormone

Desmopressin (DDAVP):

what is the main factor that will lead to the development of Disruptive Mood Dysregulation Disorder

Difficulty with attending, processing, and responding to negative emotional stimuli and social experiences

what is bipolar disorder characterized by

Discrete periods of mania or hypomania

what is the new mood disorder that has been identified and is specific to children and cannot be given to adults

Disruptive Mood Dysregulation Disorder

examples of depressive disorders

Disruptive Mood Dysregulation Disorder, Major Depressive Disorder, & Persistent Depressive Disorder

how is pre-trauma functioning involved in the development of PTSD

Elevated anxiety or depressive symptoms before exposure to trauma increases risk for PTSD

what symptoms is a good predictor for negative outcomes of bipolar disorder

Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

goal of trauma-focused CBT

Exposing children to memories or stimuli associated with the trauma and encourage them to cope with their feelings in an adaptive way

how does family conflict involved in the development of depressive disorders

Families are characterized by less cohesion, communication, and responsiveness; often very critical, experience a lot of stress

what does exposure to trauma for long periods of time experience changes to what brain function/area

HPA axis

order of the forms of maltreatment from most to least common

Most common form is neglect, followed by psychological abuse, physical abuse, and sexual abuse

gender differences for depressive disorders

Much more common for adolescent girls (2x likely)

gender difference for bipolar disorder diagnosis

No gender difference in diagnosis

gender difference for child abuse

No overall gender difference, but girls are significantly more likely to experience sexual abuse

how does social interactions involved in the development of depressive disorders

Often rejected by peers or socially withdrawn, bullying

what is the onset for bipolar disorder

Onset typically between middle adolescence and young adulthood

what is trauma-focused CBT typically recommended for

PTSD

how does family functioning play a role in the development of PTSD

Parents who provide stable, consistent care reduce the likelihood of the development of PTSD

what is the only antidepressant that is associated with consistent improvement in depressive symptoms with minimal side effects

Prozac

what two antidepressant medications have been approved for teens by the FDA

Prozac & Lexapro, others are often prescribed (off-label prescriptions)

subjective units of distress, how anxious they are feeling in the presence of these triggers

SUDS rating

example of CBT used for children: feelings barometer

SUDs rating, kid friendly

gender difference for suicide

Suicide attempts are twice as common in girls, but boys are more likely to complete suicide (use more lethal methods)

what other disorders can disruptive mood dysregulation disorder not cooccur with

This diagnosis cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder, though it can coexist with others, including major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and substance use disorders. Individuals whose symptoms meet criteria for both disruptive mood dysregulation disorder and oppositional defiant disorder should only be given the diagnosis of disruptive mood dysregulation disorder. If an individual has ever experienced a manic or hypomanic episode, the diagnosis of disruptive mood dysregulation disorder should not be assigned.

what is a characteristic selective mutism and what is selective mutism not?

ability the speak effectively and it is not a behavior problem

what percent of children between the ages of 5 and 7 have frequent daytime accidents

about 1-2%

yearly, what percent of children with enuresis recover with no treatment

about 15%

what percent of children stay dry shortly after taking it? what percent remain dry when it is discontinued?

about 25-60%, only 20%

what are the heritability estimates for OCD

about 45-58%

how long does it take for the rectum to reach original size and tone

about a year

when are social anxiety disorders typically diagnosed

after age 10, rarely diagnosed in early childhood and before age 10

how many children who meet the criteria for DMDD meet the criteria for ODD? how many children who meet the criteria for ODD meet the criteria for DMDD?

almost all, only 15%

who is most likely to exhibit reactive attachment disorder

among children adopted internationally and who spent first 12-24 months of their lives living in orphanages, longer they are exposed to more likely to develop disorder.

most common type of specific phobia? second most common?

animal most common natural environment second most common

5 types of specific phobia

animal, natural environment, blood-injection-injury, situational, other

a complex state of psychological distress that reflects emotional, behavioral, physiological, and cognitive reactions to threatening to stimuli, which can sometimes be a beneficial emotional state

anxiety

Developmentally expected fears and worries: middle school (9-12 years)

anxiety about school or tests worry about completing assignments worries about making and keeping friends, concerns about pleasing others

what is selective mutism considered

anxiety disorder

common comorbid disorders for OCD

anxiety disorders depression - after onset pretty debilitating because of embarrassment, withdraw, family conflict, lower self-esteem Tic Disorder

comorbid disorders for PTSD

anxiety, depression, suicidal ideation, substance use

what is particularly concerning about social anxiety disorders

anything that contributes to withdrawal of social interactions or social support is a risk factor for depression

what is unique about the etiology of the blood, injection, injury type phobia

appears to have a specific genetic component which is unusual because most phobias do not have specific genes

what percent of school-aged children experience encopresis

approx. 3%

Concordance rates for adult monozygotic twins reared together? raised apart? dizygotic twins?

are as high as 70-85% 67% 19%

when does GAD onset in children

around age 8-10

what age has lexapro been approved for

as young as 12 years old

what are anxiety disorders highly comorbid with

associated with the development of depressive symptoms

onset of encopresis

at least 4 years of age (or of equivalent developmental level)

onset of enuresis

at least 5 years of age (equivalent developmental level)

how long does selective mutism typically last

at least a month

how long will a manic episode last

at least a week

duration of encopresis

at least once per month for 3 months

positive reinforcement + social (purpose of NSSI)

attention from parents, friends (maybe for attention but typically a cry for help)

serves a sensory function of internal function

automatic reinforcement

why does high behavioral inhibition contribute to social anxiety disorder

avoid new/unfamiliar situations

what do children who use Escape/avoidance coping tend to do

avoid thinking, isolate themselves, substance abuse (adolescent), which leads to an increase likelihood of developing PTSD

symptoms that might indicate a disorder: elementary school (6-8 years)

avoidance of feared stimuli, refusal to attend school, extreme anxiety/panic during tests, academic problems

negative reinforcement + social (purpose of NSSI)

avoidance of social demands

what changes are seen in behavior

avoids or attempts to feel the situation if not they become panicky or clingy

what causes the NSSI and DSH behaviors to be relatively stable

awareness of these problem has increased and we are getting better at recognizing this as a behavior we should attend to

how does negative reinforcement contribute to social anxiety disorder

begin to avoid things that cause anxiety and nothing bad happens so we think nothing bad happened because we avoided the situation

example of psychological abuse

berating, humiliating, disparaging, abandoning, threatening, harming things child cares about locked in rooms, bound to furniture for long periods of time

when a person has this uninhibited bladder contraction, experience this sudden, unexpected need to go to the bathroom, not common

bladder instability

Sleep Fairy Book

brings treats or tokens when the child demonstrates good sleep behavior can fade it out with the story

why are mood ratings effective in treating depression

builds some efficacy that helps the person understand they have some control over their depression and something they can do

characteristics of Non-Suicidal self-injury

called cutting, self-harm, behavior for adolescence with depression, experience trauma, bipolar, emerging personality disorders purposely injuring yourself

characteristic and examples of sexual abuse

can be forced to watch or engage with someone else fondling, penetration, incest, sodomy, indecent exposure, exploitation, etc.

acquired capacity for death theory

can mediate the relationship between NSSI and suicidal behavior

they expect disastrous outcomes from mildly aversive effects, there is this overreaction

catastrophizing

6 cognitive distortions

catastrophizing overgeneralization dichotomous thinking mind reading personalization absolute thinking

3 common cognitive distortions for children with GAD

catastrophizing overgeneralizing personalizing

overestimating the chances of disaster expecting something terrible to happen

catastrophsizing

how does child abuse affect the child

causes significant emotional pain and physical distress

what is temperaments involvement in anxiety disorders

certain temperaments result in a greater risk to develop anxiety disorders

example of CBT used for children: athim

change those thoughts to that was a really cool spin or I am having a really good time help reconstruct the child's negative cognitions

RAD: relationship to attachment

child lacks clear attachment relationship to a caregiver

DSED: relationships to attachment

child typically shows attachments to caregivers, attachment maybe secure

when is CBT/Trauma-Focused Cognitive Behavioral Therapy typically used

children who develop diagnosis related to trauma

what is the difference between the worry level for children with GAD and children without GAD

children with GAD however report a greater number of worries and associated symptoms than their peers without GAD

tends to last longer than expected and resistant to going away

chronicity

symptoms that might indicate a disorder: preschool (4-5 years)

clinging to parents, crying, tantrums, freezing, sneaking into parents' bed at night, avoiding feared stimuli, sleep refusal, bed wetting

The way people feel about a situation depends on their evaluation of that situation

cognitive appraisal theory

worrying helps people avoid emotionally and physically arousing mental images, replace worries about more significant things with things that are more tolerable (more manageable), tend to worry about the little things

cognitive avoidance theory

Selectively attend to negative experiences while ignoring or dismissing positive aspects or experiences about themselves and their environment

cognitive biases

2 components of Beck's Cognitive Theory of Depression

cognitive biases and cognitive distortions

Interpret events in an excessively negative manner, causing them to feel hopeless or helpless

cognitive distortions

faulty thinking patterns that can contribute to this anxiety

cognitive distortions

what is the common treatment method for separation anxiety disorder, social anxiety disorder, GAD, and OCD

cognitive-behavioral therapy

what is the general recommendation for the treatment for depression

combine medication and CBT

what are children very clever at doing when it comes to specific phobias

coming up with ways to avoid the situations that produce a phobic response

what do you have to rule out before diagnosing selective mutism

communication disorders

examples of other stimuli phobias

costumed figures, mascots, clowns, chocking on food

what is the main criteria for bipolar II disorder

criteria have been met for at least one hypomanic episode and at least one major depressive disorder

impact the person's functioning in some way, missing out on going to school or afraid to go outside

degree of impairment

irritable mood =

depressive

what type of disorders were typically diagnosed in adulthood for children with chronic irritability and angry outbursts

developed depressive and anxiety disorders, but rarely bipolar disorder

2 characteristics of deep breathing

diaphragmatic breathing really helps fix the physiological component of anxiety

categorizing experiences at the extreme (either all good or all bad)

dichotomous thinking

characteristics of nonshared environmental factors associated with OCD

different for siblings who grow up in the same house parent who has OCD, child is experiencing a mother who had a more difficult pregnancy or experienced illness, family stressors

why is difficult for parents to produce this type of care

difficult because the parent was also probably exposed to the trauma or because they know something bad happened to their child so they are likely to develop PTSD symptoms too

Generalized Anxiety Disorder: Etiology

difficult temperament behavioral inhibition poor parent-child interactions (family stress) cognitive avoidance theory

temperaments role in depressive disorders

difficult temperaments tend to have more negative emotions and illicit negative reactions from their caregivers or peers, difficulty coping with stressors could predispose someone to depression

daytime

diurnal

why is it uncommon for preschoolers to experience GAD

do not have the cognitive ability to worry until around age 4 or 5

why is Eye Movement Desensitization and Reprocessing (EMDR) hard to use with kids

does not make a lot of sense to them and hard to get them engaged, adolescents it is showing some promise and for adults this a treatment that is very widely used.

why is insight harder for younger children

don't have the cognitive or reasoning ability

when is there the highest risk for suicidal thoughts when taking antidepressants

during the first few months or a change in dosage (increase or decreased)

what does selective mutism interfere with

educational achievement or social communication

what did selective mutism used to be called

elective mutism where children were believed to be doing this intentionally, but didn't support this

Repeated passage of feces into inappropriate places (clothing, floor, etc), whether involuntary or intentional, if intentional other developmental or behavioral needs that we need to affress

encopresis

what do you never do when you end a session

end it at a high level of fear wait until they are at a comfortable level to end the session

A. Repeated voiding of urine into bed or clothes, whether involuntary or intentional. usually, if it is intentional is it related to another diagnosis

enuresis

two types of toileting problems

enuresis and encopresis

what do adults report about their manic episodes

euphoric cheerful high elated expansive mood increased energy irritable mood oppositional behavior

what is the key feature of generalized anxiety disorder

excessive worrying

other factors associated with the development of OCD

excessively high levels fo serotonin - meds that inhibit serotonin reduce OCD symptoms operant conditioning -when a person experiences obsessions and engages in compulsions their anxiety is reduced so this compulsive behavior is negatively reinforcing reducing something aversive

confronting feared stimulus for a discrete period of time, overtime anxiety gradually increases

exposure therapy

4 behavior therapies that can be used for phobias and selective mutism

exposure therapy systematic desensitization contingency management for kids modeling helpful kids

What does Criterion A4 not apply to

exposure through electronic media, TV, movies, or pictures unless this exposure is work related

why do people engage in NSSI behaviors

express intense feelings, anger, feel something, or punish themselves or calm themselves down

2 treatments of childhood sleep problems

extinction graduated extinction

symptoms that might indicate a disorder: toddlerhood (2-3 years)

extreme panic when separated after age 2 years, sleep disturbance, nighttime panic attacks, oppositional behavior toward adults

the individual recognizes that OCD beliefs are definitely or probably not true or that they may or may not be true

fair or good insight

3 risk factors for adolescent suicide

family risks social and environmental risks mental health risks

a behavioral and physiological reaction to immediate threat in which the person responds to imminent danger (immediate threat)

fear

example of CBT used for children: fear ladder

fear hierarchy

what is the key component of social anxiety disorder

fear of being evaluated negatively (fear of scrutiny)

Developmentally expected fears and worries: preschool (4-5 years)

fear of separating from parent to go to preschool or day care fear of thunderstorms, darkness, nightmares, specific animals

Developmentally expected fears and worries: elementary school (6-8 years)

fear of specific objects (animals, monsters, ghosts) fears of germs illnesses fear of natural disasters or injuries anxiety about school

what are the most common obsessions

fear or harming self or others 5% sexual thoughts 5% lucky or unlucky number 10% disgust over bodily waste 10% scrupulosity (religious obsessions) 15% symmetry, order, exactness ~15% something terrible happening 25% dirt; germs 40%

what disorder does worry play a role in

generalized anxiety disorder

what does a tic disorder do to the severity of OCD symptoms

genetic similarity between the two more impairment and more severe symptoms

what determines temperament? when does it develop? is it stable overtime?

genetically-determined, developed early in life, and relatively stable

is selective mutism more common in girls or boys

girls

who is bladder instability more common in

girls

what are three specifiers associated with level of insight they have about their obsessions

good or fair insight poor insight absent insight

presentation of depressive disorders in adolescent girls

greater number and more severe symptoms and greater likelihood of self-harm

a greater number or risk factors =

greater risk for suicide should prompt parents and professionals to ask adolescents about suicidal thoughts and plans

what is the parent group similar to

group intervention strategy similar to PCIT (parent training group)

what is the importance of future-orientation

guides behavior and protects you from bad decisions don't have this you're decision making is very of the moment and how to solve problem right in this moment

what should be paired with retention control training? how many cases see success with this treatment?

half of cases, paired with urine alarm

characteristics of a Fear Hierarchy

have the person be exposed to the things that trigger their anxiety cause they are typically avoided in a very manageable way where they move up the hierarchy from the bottom to the top (lowest to highest SUD score)

what is the most common presentation of OCD

having both obsessions and compulsions

characteristics of informational transmission associated with specific phobias

hearing others talk about something scary or their own phobia can contribute to the development of a phobia

what changes are seen in physiology

heart races, rapid breathing, sweating, upset stomach dizziness, etc.

do anxiety disorders have strong heterotypic or homotypic continuity

heterotypic (continue to see a different diagnosis overtime)

why can toileting problems lead to anxiety and mood disorder

hide accidents, guilt, lower their self-esteem

examples of physical abuse

hitting, burning, kicking, shacking, stabbing, chocking

example of CBT used for children: STIC task

homework task give kids an acronym to remember these steps: FEAR F: feeling frightened - how your body responded E: expecting bad things to happen (paying attention to negative cognitions) A: attitudes and actions that can help (problem-solving skills) R: results and rewards (how can I reward myself for being able to use these steps)

tendency to attribute more hostile/negative behavior to people in their environment (the people the trust are abusive they will expect other people to be hostile as well)

hostile attribution error

What does HPA axis stand for?

hypothalamic-pituitary-adrenal axis

what does CBT involved in the treatment for depression

identifying negative cognitions and we also work towards behavioral activation

when does secondary enuresis occur

if there has been some stressful life event or frequently diagnosed with other behavioral disorders

how do children with GAD tend to worry

in a more ruminative way, overthink about these negative situations and thoughts

example of CBT used for children: the bank and reward menu

in each session have goals for the child working on exposure and give themselves points in the bank for anytime they practice their skills and they create a reward menu that indicates what they can get a fora certain number of points/stickers

positive reinforcement + automatic (purpose of NSSI)

increased feeling of pleasure (feel something when they normally feel numb)

how can NSSI lead directly to suicide

increased psychological distress

3 ways NSSI might lead to suicide

increased psychological distress third variable acquired capacity for death

when is Attachment & Biobehavioral Catch-up (ABC) most commonly used

infants and maybe with children within the first or second year

does the person recognize that their obsessions are probably not true and not going to act on them

insight

tends to be out of proportion to the threat that triggered the response

intensity

3 factors associated with maladaptive anxiety

intensity, chronicity, and degree of impairment

DSED: children's characteristics

interested in social interactions, willingly approach and seek contact with strangers

most common presentation of encopresis

involuntary related to constipation

what is depressed mood like in children and adolescents

irritable mood

why are observations important for diagnosing children

kids struggle to report feelings

what is the major component that contributes to the development of phobias

largely due to a learned component (experience or learning)

what is the difference between a manic and hypomanic episode

less severe than mania and no hospitalization is needed.

what percent of the general population can be affected by selective mutism

less than 1%

RAD: children's characteristics

little interest in social interactions, passive, do not show preference for primary caregivers

what do children who use Problem-focused coping tend to do

look for support

affect of medication on mean depression score for adolescents

lowest either with or without CBT

mental health risks for suicide

major depressive disorder PTSD bipolar disorder substance use disorder

A discrete period of dysphoria that lasts for at least 2 weeks

major depressive episode

how does classical conditioning contribute to social anxiety disorder

make mistake when reading and classmates laugh, conditioning a fear response

what happens when the NSSI behaviors are trivialized

makes people ashamed and less likely to get help, most commit suicide even though they don't want to kill themselves

tantrums =

mania

discrete period of elevated, expansive, or irritable mood, increased activity, or energy. often results in decisions that are harmful to themselves

manic episodes

RAD: associated disorders

many children also show depressed mood, irritability

few, if any, symptoms in excess of those required to make the diagnosis are present, the intensity of the symptoms in manageable, and the symptoms result in minor impairment, no suicidal ideation or behavior

mild

what are the 3 specifiers based on severity

mild moderate severe

making assumptions about other's thoughts, feelings, or behaviors

mind reading

have parent or sibling model the steps for them and when they see them have success and react without fear might help the child

modeling

the number of symptoms, intensity of symptoms, and/or functional impairment are between those specified for "mild" and "severe"

moderate

gender differences for OCD

more common in boys in childhood, gender different dissipates by adolescence and into adulthood

how does maternal depression involved in the development of depressive disorders

mother who experience depression is more likely to have a child who experiences depression, modeling emotional regulation

depressive disorder comorbidity: suicide

much more higher risk

The confirmed or suspected act or omission that deprives the child of basic age-appropriate needs and can result in physical or psychological harm (needs are not being met; education, treatment, basic needs)

neglect

attend to negative stimuli in the environment so they are more prone to negative affect (see the glass half-empty)

neuroticism

what are the two underlying traits involved in temperament that seem to predict a greater likelihood of developing an anxiety disorder diagnosis

neuroticism and behavioral inhibition

is there a difference between the social and emotional problems reported by parents and teachers for children with and without enuresis

no

do compulsions and obsessions have to be related

no, especially for children

nighttime

nocturnal

3 specifiers for enuresis

nocturnal only diurnal only both-combined type

what type of environmental factors are important

nonshared environmental factors

what are higher levels of sexualized behavior not a reliable indicator of sexual abuse

not a lot of research and the research did not support this, 66% of children of who experienced sexual abuse do not show these sexualized behaviors, tend to show precocious knowledge of sex (no more for their age)

DSED: relationship to caregiving

not associated with the quality of care

other diagnostic criteria for encopresis

not attributable to a medication or medical condition

other diagnostic criteria for enuresis

not attributable to a medication or medical condition

what is the purpose of NSSI

not for attention, manifestation of real underlying mental health problems that are not being addressed, ways to cope and feel in control

did adding CBT to medication improve the results of treatment

not significantly

when does developmentally appropriate mood elevations occur

occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania

RAD: course-prognosis

often persistent if child remains in institution; remits after child forms attachment to adoptive parents

when they think about events leading up to the trauma they think, they were signs in the environment

omen formation

most common bipolar symptoms shown by children or adolescents

on avg., youths display 5.5 of 7 possible symptoms 1. racing thoughts ~85% 2. poor judgement ~85% 3. distractibility ~80% 4. grandiosity ~80% 5. more talkative ~80% 6. increased activity ~80% 7. decreased sleep ~70%

what percent of young children; boys and girls equally likely to experience depression in childhood

only 1-2%

what is the one problem with SSRIs

only perform slightly better than the placebo

when does social anxiety disorder onset

onset around late childhood or adolescence

what are the most common compulsions

order or arranging 15% counting 15% touching 20% other rituals to remove germs 25% Miscellaneous rituals (writing) 25% checking (doors/locks) 45% repeating rituals 45% washing or grooming 85%

what are children with GAD more at risk for

other anxiety disorders and depression

what percent of adolescents reported feeling sad or hopeless almost every day for at least 2 weeks? had planned a suicide attempt? had attempted suicide? had made an attempt that required hospitalization? according to the 2004 CDC study

over 28% over 16% over 8% almost 3%

abstracting a general rule (or coming to a general conclusion) based on single isolated thought

overgeneralization

a single aversive event is indicative for future misfortune

overgeneralizing

DSM-5 Childhood Anxiety Disorders that are rare in children

panic disorder and agoraphobia

5 family & social variables involved in the etiology of depressive disorders

parent-child attachment maternal depression family conflict peer interactions social information processing

family risks for suicide

parental mental health problems history of child abuse or neglect parent-child conflict

social and environmental factors for suicide

peer rejection, social isolation romantic problems difficulty in school immediate psychosocial stressor

Taking personal responsibility for something that is not one's fault

personalization

taking responsibility of something they have no control over apologizing all the time

personalizing

•Bedtime is gradually moved later over successive nights, until the desired bedtime is achieved

phase delay

what disorder can fear play a role in

phobias

Deliberate action that results in serious (or risk of) injury to a child

physical abuse

goal of Therapeutic Foster Care

placing children with foster parents to have had some training, in addressing some of these issues really making sure these parents and families are supported in a variety of ways

the individuals think that OCD beliefs are probably true

poor insight

who is GAD unusual for

preschoolers

What conclusion did this data come to about DMDD

presentation of depression that is specific to childhood, without treatment it will start to look like typical depressive disorders

•Children who have never been able to stay dry during the night

primary enuresis

tensing and releasing different muscles in the body

progressive muscle relaxation

what SSRIs is the most often prescribed for children and adolescents

prozac

Nonaccidental verbal or symbolic acts by a parent or caregiver that results in significant psychological harm to a child

psychological abuse

2 components of toilet training readiness

psychological and physical readiness

Examples of sexualized behaviors that can be seen in a child that experience higher levels due to sexual abuse

public masturbation preoccupation with sex sexualized played with dolls sexual activity with playmates seductive language in seduction

why are we learning about bipolar disorder in children

rare for children, but want to differentiate it from the other mood disorders

RAD: frequency

rare in institutionalized children; almost never seen in children adopted out of institutions

why do some children and adolescence not get treatment

really embarrassed go out of their way to avoid triggers dont understand disorder

two or more major depressive episodes with at least 2 months between episodes in which the individual does not meet criteria

recurrent

what is the trend of NSSI and DSH over the last few years

relatively stable

what is the treatment of encopresis involve

relieving constipation and teaching children to use the toilet regularly

Protect children from the potential harmful effects of risk

resilience

what causes children to not develop PTSD even though they are exposed to trauma

resilience factors are available

Sleep-ADHD connection

restricted oxygen to the brain can caused ADHD-like behaviors or symptoms, lose their ability to self-regulate, look hyperactive or inattentive and have too much energy

have children drink excess fluids and hold there urine as long as possible to help expand bladder capacity

retention control training

Increase the likelihood that a child will develop a particular disorder

risk

symptoms that might indicate a disorder: middle school (9-12 years)

school refusal, academic problems, procrastination, insomnia, tension or restlessness, social withdrawal, timidity, extreme shyness in social situations, persistent worry

•Children who had previously been toilet trained for at least 6 months and then began to show enuresis

secondary enuresis

how does the cognitive appraisal theory lead to the development of PTSD

see the trauma as personally relevant typically feel more distress than those who are able to cognitively distance themselves, children who knew someone or perceived being harmed by the 9/11 attack are more likely to develop

what is the subtype of social anxiety

selective mutism

corresponding DSM-5 Anxiety Disorder: toddlerhood (2-3 years)

separation anxiety disorder

what anxiety disorder is seen in elementary school? High school

separation anxiety disorder social anxiety disorder

corresponding DSM-5 Anxiety Disorder: preschool (4-5 years)

separation anxiety disorder specific phobia (natural disaster) specific phobia (animals)

DSM-5 Childhood Anxiety Disorders that are common in children

separation anxiety disorder - much more common in children specific phobia social anxiety disorder selective mutism generalized anxiety disorder

two neurotransmitters associated with depression

serotonin and norepinephrine (the monoamine hypothesis)

the number of symptoms is substantially in excess of the required to make the diagnosis, the intensity of symptoms is seriously distressing and unmanageable and the symptoms markedly interfere with functioning some suicidal ideation or behavior

severe

sleep pattern by 9 months

sleep through the night typically 14-15 hours (6-7 at night and 2-3 daytime naps)

examples of animal phobia

snakes, spiders, dogs, birds

what is the most commonly diagnosed anxiety disorder

social anxiety disorder

corresponding DSM-5 Anxiety Disorder: high school (13-18 years)

social anxiety disorder generalized anxiety disorder panic disorder, agoraphobia

corresponding DSM-5 Anxiety Disorder: middle school (9-12 years)

social anxiety disorder generalized anxiety disorder

DSED: cause

social deprivation in infancy

RAD: cause

social deprivation in infancy

what do adolescents typically fear

social situations (being left alone or failing an exam)

DSED: associated disorders

some children show hyperactivity-impulsiveness

causal factors of selective mutism

some heritability, but most follow the triple vulnerability model\

what SUDS rating is typically used for children

something that is more tangible, visual, and concrete usually involve faces where they point to the face that describes how they are feeling

DSED: frequency

sometimes seen in institutionalized children, children adopted out of institutions and maltreated children

corresponding DSM-5 Anxiety Disorder: elementary school (6-8 years)

specific phobia (animals, situations)

what do you still use during CBT

still use reinforcement, exposure and deep breathing but add a component that focuses on changing negative thoughts

pairing the exposure with the deep breathing or progressive muscle relaxation, exposing them to the steps of the fear hierarchy and we are coaching them using deep breathing or progressive muscle relaxation

systematic desensitization

why is cleanliness treatment important

teach the child to clean up their accidents

example of CBT used for children: the muscles of the body

teaching the child to identify the physiological response to anxiety and how to do progressive muscle relaxation

what age is self-harm most often seen in

teens

child's characteristic ways of interacting with the world

temperament

what personality factor do genetic factors contribute to

temperament

what changes are seen in cognition

tend to make negative self statements that maximize danger of the situation and minimize their ability to cope

what false correlation do parents hold about enuresis

that punishment stops this behavior, punishment does not work

black box warning =

the FDAs most serious warning they can put on a drug

what area of the brain do children with Disruptive Mood Dysregulation Disorder show dysregulation in

the areas that is responsible for interpreting and expressing emotions

what is sexual abuse related to

the child's age or difference in age

what does the type of fear show about a child

the cognitive development of the child

what factor of the triple vulnerability method is temperament involved in

the first one (biology and genetics)

why are we talking about toileting problems

the impact it has on families

when do you have to specify the individuals OCD is tic-related

the individual has a current or past history of a Tic Disorder

what is different about psychological abuse

the most difficult to prove and is usually demonstrated with the other types of abuse

what contributes to the likelihood of developing PTSD

the traumatic event that is experienced

what is the prevalence of PTSD dependent on

the type of trauma

examples of natural environment phobias

thunderstorms, heights, water

3 associated disorders with OCD

tic disorder Trichotillomania Excoriation Disorder

when is the onset of selective mutism

toddlerhood and preschool, not typically diagnosed until the child starts to attend school where it really begins to impair their functioning in some way

write out a story, song, poem, comic book, etc that talks about the trauma (labeling the trauma) - address trauma head-on so they do not feel as ashamed (something they should talk about) and still seek out help, share it with a parent, caregiver, or someone they trust

trauma narrative

simually in the environment (location where the trauma occurred or a person that was present, a sound that reminds them of the trauma) don't just remind them of the trauma they create the same response as the trauma did. re-experience feeling of fear and panic similar to the trauma

trauma reminders

Development of fear & anxiety related to sexuality or establishment of relationships

traumatic sexualization

how do you prevent constipation

try to sit on the toilet everyday to go to the bathroom especially after eating feet flat to the group and sit up straight

how often does enuresis have to occur

twice weekly for 3 months or causes distress or impairment

phobias develop through classical conditioning or observational learning but their maintained through operant conditioning

two-factor theory of specific phobias

why do we need to stop using pull-ups

unaware of their accidents

what do children with GAD have a tendency to do

underestimate their ability to cope with events so tendency to believe that events and situations are largely determined by external causes and they have no control over that.

goes off when it detects urine so you begin to pair that sensation with actually waiting and make sure child gets up to go to the bathroom

urine alarm

why are relaxation strategies a big component of the treatment for anxiety disorders and OCD

used to manage the physiological component of anxiety

DSED: course-prognosis

usually persists into childhood even if child is adopted

when is supportive therapy typically used

utilized when child is still in the trauma situation (in the home where the abuse is occurring)

what is the disadvantage of Desmopressin (DDAVP)

very expensive, does not work all children cause not all children have a problem with this hormone

children get engrossed in their daily activities, having fun, not paying attention to signals from their bladders (fidgeting and potty dancing), don't get there in time and end up having an accident can grow out of this

voiding postponement

what is the belief will happen if we change these negative thoughts using CBT

we can change their behaviors and reduce the feelings of anxiety

when is reactive attachment disorder specified as severe

when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.

when do disorders of social deprivation typically occur

when children are exposed to extreme social deprivation-both very rare and expect to see early in life when children experience neglect and frequent changes in placement

when is disinhibited social engagement disorder specified as severe

when the child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.

when do you want to practice these relaxation strategies skills

when they are not anxious and gets the parents involved so they could get good at these skills so they have them when they are feeling anxious

2 specifiers for encopresis

with constipation and overflow incontinence (long history of constipation) without constipation and overflow incontinence (never mastered potty training)

primarily a cognitive response to a threat, where a person considers and prepares for future danger of misfortune (preparing for a future threat)

worry

do children with and with GAD worry about similar topics

yes

example of CBT used for children: cognitive reconstructing

you have the child fill in what they think a person in a picture is thinking typically say afraid he is going to fall or afraid that everyone is going to laugh

what should you do if you get answers to any of these questions that are concerning

you need to get them help right away

what age has prozac been approved for

young as 8 years old

prevalence of panic disorder

~0.5%

likelihood of developing bipolar disorder

~1

likelihood of developing major depressive disorder

~1.35

likelihood of developing generalized anxiety disorder

~1.7

likelihood of developing persistent depressive disorder

~1.8

Prevalence of Agoraphobia

~3%

prevalence of separation anxiety disorder

~3.5%

prevalence of generalized anxiety disorder

~5%

prevalence of specific phobia

~6%

prevalence of social anxiety disorder

~7%

3 characteristics of extinction

•"Cry it out" - no longer reinforcing the behaviors we do not want to see •After the child is put to bed, the parent ignores the child's behaviors until the morning •Stressful!!!!!!! - very clever at figuring out how much they need to escalate their behaviors -ineffective and does not work

how is proximity to trauma involved in the development of PTSD

•"Dose-related response" •Children can develop trauma by hearing about a catastrophic event happening to their loved ones •the longer, the more intense, direct the trauma is the higher the likely to develop PTSD

Enuresis Assessment

•"Go no further" - make sure there is not any other medical issues that need to be addressed, talk to pediatrician to rule out anything before going further •Family history and medical variables - genetic background •What has the family tried already? - tells you about the motivational levels of both parents and child •Motivational level of child and family - lengthy treatment process •Toilet training readiness •Baseline data on frequency of bedwetting - using a calendar tracking wet and dry nights, track progress with treatment

depressive disorder comorbidity: anxiety

•40-50% of youth with depression have at least one anxiety disorder •Social anxiety disorder is the most common comorbid diagnosis •Separation anxiety is common for young children with depression

3 associated problems with enuresis

•ADHD - 3x more likely •Family stress - parents may make the problem worse contribute bed wetting to laziness, defiance punishing •Anxiety or mood problems - not a cause happen as a result

Physical Readiness

•Appropriate motor skills •Reflex sphincter control •Nervous system readiness (mature enough to handles this, going to take practice, takes a lot of skills - being able to detect the need to urinate and inhibiting urination)

Sleep problems assessment

•Bedtime difficulties - not compliant, tantrums, argue, curtain calls •Excessively sleepy - sleep in the car, school, watching TV •Awaken during the night - difficult time going back to sleep •Regular sleep-wake schedule •Snoring

2 factors that contribute to daytime bed wetting

•Bladder instability •Voiding postponement

gender difference for encopresis

•Boys are 4-6 times more likely to develop encopresis

RAD vs. ASD

•Children with RAD must have histories of extreme social-emotional neglect (hard to track sometimes) •Children with RAD show few attachment behaviors (do not seek comfort and do not respond to comfort given); children with Autism show attachment behaviors commensurate with their developmental level •Children with RAD usually do not demonstrate restricted interests or ritualized behaviors (harder to use as a distinction because children who are severely abused tend to develop odd, unusual, ritualistic patterns of behavior)

depressive disorder comorbidity: disruptive behavior

•Comorbidity of ADHD: 12-45% •Comorbidity of ODD or CD: 23% •Predicts more negative outcomes

Encopresis Treatment: Basic Strategies

•Empty large intestine (work with pediatrician) - prescribe laxative •High fiber diet •Increase fluid intake •Provide family education - how this develops and how to produce healthy bowel movements •Eliminate punishment - not on purpose or something that they can control •Exercise

Treatment of Childhood Sleep Problems: sleep-onset type

•Fading sleep-onset associations •Gradually remove the sleep onset cue over time; for example: •Fade milk in a bottle over time to water •Fade parental presence by moving parent further and further away •Fade television by dimming brightness and lowering sound -not tricking the child telling them exactly what we are doing and provide reinforcement

Impact of Physical/ Psychological Abuse & Neglect on the child's behavioral and academic problems

•Frequently diagnosed with ODD or CD •Increased risk for aggression (hostile attribution bias) •More likely to engage in antisocial behavior •Girls are at risk for underemployment and prostitution later in life •At risk for low academic outcomes

2 characteristics of graduated extinction

•Ignore disruptive bedtime behaviors for a specific period of time •Increase duration between check-ins gradually

4 childhood sleep problems

•Insomnia Disorder •Circadian Rhythm Sleep-Wake Disorder •Sleep Arousal Disorder - very rare for children •Obstructive Sleep Apnea

Encopresis Assessment

•Is there ever a long period between bowel movements? •Are the bowel movements often large? •Does the fecal matter have an unusually foul odor? •Is the bowel movement painful for the child? •Does the child complain that they do not know when they will have a bowel movement? •Does the child ever hide soiled underwear? - really embarrassed afraid of getting into trouble •baseline data - when bowel movements occur and what they look like

associated problems with encopresis

•May be more likely to experience social & emotional problems, so embarrassed and socially withdrawn could begin to look like autism

gender difference for enuresis

•More common in boys (6.2%) than girls (2.5%), components of the nervous system involved take longer to mature in boys

depressive disorder comorbidity: substance abuse

•More likely to abuse substances than peers

Normal Toilet Training

•Most children have achieved diurnal bowel and bladder control by 3 years of age (success between ages 2 and 3) •Accidents often occur through 5 years of age

4 characteristics of Obstructive Sleep Apnea (Disordered Sleep Breathing)

•Often a cause of sleep arousal disorders •Occurs when a child's airway is constricted of blocked during sleep (snoring, gasping) •Strong relationship to attention problems and irritability •Treatment often involves removal of tonsils or CPAP device - enlarged tonsils or frequent sinus or ear infections

how does social information processing involve in the development of depressive disorders

•Overly attend to negative social interactions (snarky comments, someone making fun of them), not positive interactions

Characteristics of Circadian Rhythm Sleep-Wake Disorder

•Persistent or recurrent sleep disruption caused by an alteration of the person's circadian rhythm and his or her daily schedule •Causes significant daytime sleepiness •Approx. 7-10% of adolescents meet criteria -partially due to the natural shift to the sleep-wake cycle during adolescents

2 Treatments of DSPS

•Phase delay •"bright light" therapy is also beneficial in some cases - not as effective but much easier approach to treatment

"the excuse me drill": graduated extinction example

•Positive attention (e.g., physical touch, verbal praise) was provided as long as Jenny was lying quietly in her bed. •Ms. Smith then said "Excuse me, I need to ..." and briefly left the room. Ms. Smith made sure to be out of the room when Jenny actually fell asleep. •Ms. Smith would return to Jenny and provide attention for appropriate behaviors. Inappropriate behaviors (e.g., crying out, out of bed) were ignored. •Ms. Smith's absences from the room grew longer over successive nights.

what is the impact of toileting problems on the families

•Possible embarrassment •Pressure from other family members •Social withdrawal •Financial issues

Assessment of Childhood Sleep Problems: Sleep Hygiene - good sleep practices

•Put your children to bed when they are sleepy •Reduce or avoid naps •Create a quiet sleep environment •Reduce light •NO TELEVISION OR VIDEO GAMES!!!!!!!!!!!!!! •Structured bedtime routine •Structured sleep schedule - should be the same even on weekends

2 disorders of social deprivation

•Reactive Attachment Disorder •Disinhibited Social Engagement

5 methods for the assessment of childhood sleep problems

•Sleep hygiene •Sleep schedule •Medical issues •Behavioral issues •Family issues

Sleep Arousal Disorders

•Sleepwalking •Sleep terrors •Most often occur 60-90 minutes after sleep onset •Occur during slow-wave sleep - not getting enough oxygen to your brain so tries to wake you up but can't because you are into deep of sleep •Children are generally unresponsive during an arousal episode •Episodes are usually brief (10-30 minutes) •Children usually go back to sleep, & have no memory of the episode •always connected to disordered sleep breathing or sometimes when children are not getting enough sleep •get stuck between sleep and awake

PTSD in Preschoolers & Young Children: DSM-V Criteria - up to 5-6 years of age

•Symptoms are expressed in terms of actions or observable behaviors - relying on children reporting symptoms is difficult for younger children to do •Must show only one persistent avoidant symptom OR one negative alteration to meet criteria •Symptoms must cause distress, interfere with their behavior at school, or impair relationships with others •must focus on observable behaviors

4 behavioral treatments for nocturnal enuresis

•Urine alarm •Cleanliness training •Retention control training •Reinforcement strategies

Encopresis Treatment: Scheduled Sits

•Use toileting chart to schedule regular toilet sits •Sits should occur 5-10 minutes after a meal •Children should practice Valsalva movement •Include a reinforcement component

psychological readiness (delays for individuals w/ ID, autism, and other developmental disorders)

•Verbal understanding of the steps of toileting •Compliance - following instructions especially in other areas •Positive relationship with adults •Identification with others •Desire to master potty process - easier to be in a diaper but they want to be like others

Separation Anxiety in older children (adolescents)

•Worry about more realistic events (auto accident, general sense of harm) •May demonstrate social withdrawal, concentration problems, and depression when separated from family members (can but experience significant distress) •3-4% of children will actually meet the diagnostic criteria for separation anxiety disorder

Separation Anxiety in younger children (6-10 years)

•Worry about physical harm befalling themselves or their parents •May refuse to attend school •Often "shadow" parents from room to room

Generalized Anxiety Disorder: Diagnostic Criteria

■ Excessive worry and anxiety (apprehensive expectation), occurring most days for at least 6 months, about a number of events and activities (work or school performance) ■ Unable to control worry ■ Anxiety/worry associated with at least 3 or more of the following (with at least some of the symptoms occurring most days for at least 6 months): only one of these symptoms are needed for children because they are more difficult to spot - Restlessness or feeling keyed up or on edge - Easily fatigued - Difficulty concentrating or mind going blank - Irritability - Muscle tension - Sleep disturbance (difficulty falling asleep, staying asleep or restless unsatisfying sleep) ■ the disturbance is not attributable to the physiological effects of a substance or another medical condition ■ the anxiety or worry causes clinically significant distress or impairment in social, occupational, or other important areas of functioning ■ the disturbance is not better explained by another mental disorder

When is acute stress disorder diagnosed?

■Assigned when people show PTSD symptoms for at least 3 days but less than 1 month -Intrusive symptoms -Avoidance symptoms -Dissociative symptoms -Negative mood -Arousal symptoms

4 types of bipolar disorders

■Bipolar I Disorder ■Bipolar II Disorder ■Cyclothymic Disorder ■Other Specified Bipolar Disorder

Course of PTSD

■Children tend to demonstrate persistence of symptoms over time ■Even children who do not continue to meet criteria demonstrate some symptoms (irritability, sleep problems) ■symptoms do not just go away when they are not exposed to the trauma anymore

risk factors for Alex

■Chronic abuse ■Unstable environment ■Parent substance use ■Prematurity ■Low SES ■Parent mental health & health factors

What 4 theories contribute to the development of phobias

■Classical conditioning ■Observational learning ■Informational transmission ■Operant conditioning

Persistent Depressive Disorder: Diagnostic Criteria

■Depressed mood for most of the day, for more days that not, for at least 2 years (in children and adolescents, mood can be irritable, and duration can be 1 year) ■Presence of two or more of the following while depressed: ■The individual has never been without the symptoms for more than 2 months at a time

Characteristics of Psychological First Aid

■Foster a sense of safety ■Promote calming ■Increase self-efficacy ■Achieve connectedness and social support - take cues to determine help needed ■Instill hope for the future ■set of actions and thought that providers the kind of support for survivors to rebound and survive (reduce distress) ■focus on physical needs first and the mental health needs ■protect, listen, calm, connect, direct

Specific Phobia: case example Gabbie

■Gabbie, 5 years old ■Specific fear of dogs after a neighbors dog barked at her ■Refused to go to school after her teacher talked about having a dog ■Would cry and cling to parents any time she heard a dog ■Began to generalize to cats

Separation Anxiety: Etiology

■Genetic factors may predispose a child to the development of SAD (temperament factors play a role) ■Quality of parent-child relationships appears to be the most important predictive factor. -Early attachment relationships: seems to be the most important factor; children who do not establish a good attachment with their parents can be a good predictor ■Parents' level of anxiety ■parents tend to be overprotective, over-involved, highly controlling, do not encourage independence, and model fear and anxiety (can learn maladaptive behaviors and are not teaching independence and coping skills just about the anxiety) - finding nemo

3 questions asked in a suicide assessment

■Have you ever thought about killing yourself or wished you were dead? ■Have you ever done anything on purpose to hurt or kill yourself? ■If you were to kill yourself now, how would you do it?

steps in CBT

■Identify feelings and somatic sensations associated with anxiety ■Recognize and modify negative thoughts ■Learn cognitive problem-solving skills ■Reward selves for addressing a feared situation ■Practice in community ■teaching clients how to identify their anxiety

resilience factors for Alex

■Intelligence ■Temperament ■Creativity ■Other adult figures ■Siblings ■Positive outlook ■Work ethic

3 impacts of sexual abuse on the child

■PTSD, Depression, Anxiety ■Sexualized behavior (higher levels) -Not a reliable indicator of sexual abuse ■Traumatic sexualization

3 treatments for Disruptive Mood Dysregulation Disorder

■Parent training ■Cognitive behavioral interventions (mood disorders can show a lot of mood dysregulation) ■Family therapy (parents and children the skills needed to address their needs)

PTSD: most common traumatic events

■Physical or sexual abuse ■Witnessing domestic violence ■Neighborhood violence ■Natural disasters ■Human-made catastrophic events (bombings or shootings) ■Motor vehicle accidents

3 Trauma-Related Disorders

■Post Traumatic Stress Disorder ■Reactive Attachment Disorder ■Disinhibited Social Engagement

3 Treatments for PTSD

■Psychological first-aid ■Trauma-focused CBT ■Eye Movement Desensitization & Reprocessing

medication management of Anxiety Disorders

■SSRIs are most studied (Prozac, Zoloft, Paxil, Luvox) - reduce high levels of serotonin ■Two RCTs have shown positive effects for children and adolescents ■Best results when combined with CBT ■most of the time effective treatment will involve components of both treatment methods.

Separation Anxiety: Case Example Sarah

■Sarah, 9 years old ■History of parental anxiety & family conflict ■Refusing to attend school and to be alone in the home ■Tantrums and claims of feeling sick on school days ■Parents were adjusting their work schedule to attend school with Sarah

why is child abuse so underreported

children may still love their parents hesitant to report because they don't want their parents to get in trouble or have been threatened by their abuser to hide the abuse or neglect.

Developmentally expected fears and worries: high school (13-18 years)

concerns about acceptance and rejection by peers, teachers worries about grades, sports, relationships

what do young children typically fear

concrete things (animals, monsters)

example of a fear response

flight or fight response

how do children without GAD tend to worry

in a more problem solving way tends to not contribute to GAD like ruminative worry does.

what can be done to prevent conduct disorder

put things in place to correct trauma because we understand trauma is at the root of it.

what is the range for a SUDS rating

range from 0 (calm, no distress) to 100 (feeling so much stress you can't function and can't make decisions), you can also change it to 0 to 4 for children

Negative reinforcement + automatic (purpose of NSSI)

reduction in emotional pain

Impact of Physical/ Psychological Abuse & Neglect on the child's anxiety and mood disorders

•About 25% develop PTSD •Depression and Anxiety disorders are common •Symptoms persist beyond the end of the abuse

Treatment of Childhood Sleep Problems: positive reinforcement

•All interventions should contain a positive reinforcement component •Reinforce the desired sleep and bedtime behaviors!

what symptoms are often shown by a child with encopresis

•Complain of clothes feeling tight •State that they "can't go" •Complain of pain related to bowel movements •Have poor appetite

Sleep Problems in Adolescence: Delayed Sleep Phase Syndrome

•Delayed Sleep Phase Syndrome: a person's sleep-wake cycle is delayed by 2 or more hours •Sleep onset is typically postponed •People with DSPS often: •Feel tired during the day •Have a difficult time waking up •Have a difficult time falling asleep

2 factors that contribute to the development of enuresis

•Difficulty responding to signals of a full bladder during sleep •Difficulty inhibiting urination during sleep remain asleep even after bedwetting

3 common features of elimination disorders

•Disruptions in typical behavioral development (deviation from typical development, disruptive to the family dynamic and can be associated with other behavioral or mental health problems) •Dependent on physiological and psychological functioning (have to have a certain level of physiological or psychological maturation) •Development of elimination and sleeping skills occurs within the context of the relationship with the caregiver (important component of treatment)

Impact of Physical/ Psychological Abuse & Neglect on the child's physical health

•Failure to thrive •Bruises, broken bones, burns, scars •Head trauma or neurological damage

3 treatment strategies used for trauma-related disorders/child who experience abuse

■Supportive Therapy ■Parent Training (PCIT) ■ CBT/Trauma-Focused Cognitive Behavioral Therapy

How Trauma and Conduct Disorders strongly related

■Trauma can violate trust, disrupt attachment, and interfere with empathy ■Creates a perpetual state of alert and difficult emotions ■Diminishes future-orientation ■Learning and academic problems can create a sense of failure and depression ■Social isolation is also common ■Several studies have identified trauma as a predictive factor for antisocial behavior ■trauma can really affect development

Any sexual act involving a child that is intended to provide sexual gratification to a parent or caregiver

sexual abuse

not typical sexual behaviors for their age or the situation

sexualized behaviors

what type of environmental factors are important for the development of depressive disorders

shared

examples of blood, injection, injury phobia

shots, needles, hospitals, blood

what is difference between PTSD and acute stress disorder

show the same symptoms but for a shorter duration in acute stress disorder

problem with CBT alone for the treatment of depression

showed the same affects as the placebo

Developmentally expected fears and worries: toddlerhood (2-3 years)

shyness; anxiety with strangers fear of separation from anxiety

only one major depressive disorder

single episode

2 specifiers based on course of disorder

single episode or recurrent episode

what do older children typically fear

situational fears that might cause harm to themselves

the individual is completely convinced that OCD beliefs are true (poorer prognosis and more impairment in functioning)

absent insight

beliefs that involve "must", "should", or"have to"

absolute thinking

symptoms that might indicate a disorder: high school (13-18 years)

academic problems, persistent worry, sleep/appetite disturbance, depressed mood or irritability, substance abuse, recurrent panic attacks, social withdrawal

examples of specific situation phobias

airplanes and elevators

what is the common treatment method for phobias and selective mutism

behavior therapy

extreme shyness, withdrawal in new situations, not adventurous or outgoing

behavioral inhibition

amount of sleep needed for 1-2 years

12-14 hours, one daytime nap

how much sleep do newborns need

16-18 hours, 3-4 segments over 36 hours

why do we see hyperactivity in PTSD

overactivity of the fight or flight response that is why we see hyperactivity

what is the child group similar to

a cognitive-behavioral approach, learn to recognize emotions and develop strategies to get calm (relaxation strategies)

what is CBT used for

a more cognitive component (cognitive distortions)

what is NSSI considered to related to suicide

a risk factor that could increase your risk, not trying to kill themselves

RAD: relationship to caregiving

associated with a lack of sensitive and responsive care

who are the most likely perpetrators of sexual abuse

biological fathers, stepfathers, or other men living in the child's home (people they know well and who they have known for a long time

who are the most likely perpetrators of physical abuse, psychological abuse, and neglect

biological parents or stepparents

a mood disorder characterized by manic symptoms

bipolar disorder

what percent of boys and girls by high school self-harm

boys: 6% girls: 10%

what categorizes GAD

cognitive distortions

provide some type of reinforcement for each step of the hierarchy

contingency management

characteristics of differences in brain structure associated with OCD

cortico-striatal-thalamic circuit -the orbito-frontal circuit detects irregularities in the environment (hands are dirty) sends a message through the striatum to the thalamus ---striatum regulates the message ---thalamus tells your body what to do or how to react (sends info to different parts of the brain) -for most people that message is sent one time -people with OCD the striatum is not regulating the message properly so instead of it being sent once it is sent multiple times

which relaxation strategy is the most convenient

deep breathing

2 relaxation strategies used for the treatment of anxiety disorders and OCD

deep breathing and progressive muscle relaxation