Exceptional Children Exam 2
what percent of kids with MDD also have a comorbid personality disorder? Which is most common? What is this?
60% of adolescents with MDD have a comorbid personality disorder, which is most commonly borderline personality disorder—characterized by instability of interpersonal relationships, self-image, and affects and marked impulsivity
How long does the average episode of MDD in clinically refered patients tend to last? How does this compare to communicty samples?
8 months - longer if parent has history of depression Initial episodes are of shorter duration in community samples, with the average ranging from 4 months in childhood to 2 months in adolescence
What percent of kids with depression show significant impairments in their daily functions?
90% of youngsters with depression show significant impairment in their daily functions, and, even when they recover from their depression, they are likely to experience recurrent bouts of depression and continued impairments
How does disruptive mood dysregulation disorder (DMDD) relate to ODD and other disorders?
A diagnosis of DMDD cannot coexist with ODD (in this case. a diagnosis of DMDD only would be made) or bipolar disorder (in this case. a diagnosis of BP would be made), but can co-occur with MDD, ADHD, CD, or substance-use disorder
Does MDD go away?
almost all young people eventually recover from their initial depressive episode, their disorder itself, unfortunately, does not go away . MDD has a chance of recurrence of about 25% within 1 year, 40% within 2 years, and 70% within 5 years. Thus, a significant number of youngsters develop a chronic, relapsing disorder that persists into young adulthood
When do sex differences in diagnosable depression begin? What is found after this change?
between ages 13 and 15, when the rate rises for girls rates of depression as well as sex differences in rates increase dramatically between ages 15 and 18 The ratio of girls to boys is about 2:1 to 3:1 after puberty, a pattern that continues throughout adolescence and adulthood
Why is the presence of a co-occuring disorder significant?
can increase the risk for recurrent depression, increase the duration and severity of depressive episodes, and increase the risk for suicide attempts. The presence of another disorder also decreases a depressed youth's response to treatment and is related to less effective treatment outcomes
What are the symptoms of P-DD?
characterized by poor emotion regulation, which includes constant feelings of sadness, feelings of being unloved and forlorn, selfdeprecation, low self-esteem, anxiety, anger, and temper tantrums . Some may experience double depression, in which MDD is superimposed on the child's previous P-DD, causing the child to present with both disorders
Why do kids with depression tend to have adverse relationships with others?
children commonly notice depression-relevant cues such as sad facial expressions more often than positive cues such as happy facial expressions - en the importance of accurately reading emotional cues for successful social relationships, these selective attentional biases can contribute to adverse relationships with family members and peers.
Why is it hard to know if P-DD is a mood disorder or personality disordeR?
chronic nature seems to follow a chronic course that is typical of mood disorders, and the similarities between P-DD and MDD in young people suggest that it is a mood disorder, not a personality style
What symptoms tend to be seen in preschool children whoa re depressed?
may appear extremely somber and tearful, lack the exuberance, bounce, and enthusiasm in their play that characterize most preschoolers, display excessive clinging and whiny behavior around their mothers, fears of separation or abandonment. In addition to getting upset when things do not go their way, many are irritable for no apparent reason. Negative and self-destructive verbalizations may occur, and physical complaints such as stomachaches are common
are girls or boys more likely to be successful in their suicide attempt?
since girls typically do not use guns, they are usually less successful in completing suicide than boys
How does dpression relate to problem solving?
use ineffective styles of coping in social situations. For example, they use less active and problem-focused coping and more passive, avoidant, ruminative, or emotion-focused coping
How does GAD effect boys and girls?
equally common in boys and girls, with a slightly higher prevalence in older adolescent females
Is bp heritable?
BP is one of the most heritable forms of mental disorder
What is interaction SOC?
talking to others at a party
Can publicity about a suicide increase risk of copycat behaviour? What is this called?
"Werther effect" - media publicity can cause copycat behaviour - well documented effect from newspapers, TV in many countries
What is another name for gad?
'what if disorder'
What is hte locus ceruleus? How is it related to anxiety?
("deep blue place") is a major brain source for norepinephrine, an inhibitory neurotransmitter. Overactivation of this region is presumed to lead to a fear response, and underactivity to inattention, impulsivity, and risk-taking. Abnormalities of these systems may be related to anxiety states in children
What are the two things that must follow within 1 month after a panic attack
(1) Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, "going crazy") (2) Significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations). *at least one must occure
What are obsessions?
(1) Recurrent and persistent thoughts, urges, or images that are experienced, at sometime during the disturbance, as intrusive and unwanted, and that in most individuals cause 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 (i.e., by performing a compulsion).
What are Compulsions?
(1) Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. (2) The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive. Note: Young children may not be able to articulate the aims of these behaviors or mental acts
What is systematic desensitization? What are the three steps?
(1) teaching the child to relax; (2) constructing an anxiety hierarchy (3) presenting the anxiety-provoking stimuli sequentially while the child remains relaxed. With repeated presentation, the child feels relaxed in the presence of stimuli that previously provoked anxiety.
What is Generalized Anxiety Disorder?
(A) Excessive anxiety and worry (apprehensive expectation) occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). (B) The individual finds it difficult to control the worry.
What are the three requirements for a diafgnosis of OCD?
(B) The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (C) The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. ( D) The disturbance is not better explained by the symptoms of another mental disorder.
What are the 7 other requirements for a diagnosis of agoraphobia?
(C) The agoraphobic situations almost always provoke fear or anxiety. (D) The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. (E) The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context. (F) The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. (G) The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. (H) If another medical condition (e.g., inflammatory bowel disease, Parkinson's disease) is present, the fear, anxiety, or avoidance is clearly excessive. (I) The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder. Note: Agoraphobia is diagnosed irrespective of the presence of panic disorder. If an individual's presentation meets criteria for panic disorder and agoraphobia, both diagnoses should be assigned.
What are the 3 other requirements to diagnose with GAD?
(D) The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (E) The disturbance is not due to the general physiological effects of a substance (e.g., a drug of abuse, a medication) or a another medical condition (e.g., hyperthyroidism). (F) The disturbance is not better explained by another mental disorder.
What should one look for before diagnosing a SOC?
(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 danger posed by the social situation and to the sociocultural context. (F) The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. (G) The fear, anxiety, and avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. (H) The fear, anxiety, and avoidance is not attributable to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) 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, body dysmorphic disorder, or autism spectrum disorder. (J) If another medical condition (e.g., Parkinson's disease, obesity, disfigurement from burns or injury) is present, the fear, anxiety, or avoidance is clearly unrelated or is excessive.
What is the prevalence of selective mutism? How does this compare for different genders and sexualities?
0.7% - rare - doesn't vary by race or gender
What are the 3 basic steps to intervention witha suicidal person?
1. Show you care 2. Ask about suicide 3. Get help
What are the 6 things that need to be considered when relating maternal depression to childhood depression?
1. family difficultiess related to many other child disorders, and they may not be specific to depression 2. difficult to know whether family problems are the result of one or more co-occurring conditions, such as child conduct problems, or maternal anxiety disorder or antisocial behavior, rather than depression. It is generally found that, although statistically significant, severity of maternal depression by itself accounts for only a small amount of the variance in child outcomes, indicating that other risk factors will also need to be considered 3. most studies are correlational, making it impossible to determine the direction of influence. An adverse family environment can lead to child depression, but child depression may also evoke negative and critical reactions from family members and produce distress in others. 4. another factor, such as genetic risk, may account for both depression and family disturbances 5. protective factors in the mother or child may reduce the risk of negative child outcomes 6. a shortcoming of existing research has been the relative lack of attention to fathers with depression. A steadily growing number of studies indicate that paternal depression has significant but small effects on parenting, with depressed fathers showing less positive and more negative parenting behaviors than those who are not depressed
how many youths in the US use antidepressant medication?
1.4 million
What proportion of kids with OCD meet the criteria for this disorder later?
1/2 -2/3 fewer than 10% show complete remission, and many experience interpersonal problems, work difficulties, and lower quality of life as adults
Until what age is SOC very rare?
10, and it generally develops after puberty, with the most common age at onset in early- to mid-adolescence
What percent of us have a inhibited temperament from birth?
15%
What proportion of youth with SOC also suffer from major depression?
20%
What proportion of kids experience specific phobias?
20% - 1/5 - less than a quarter - those with disoder tend have multiple phobias
By age 6 what proportion of girls ahve experience aniety compared to boys? What is one reason for this?
2x boys are less likely than girls to report anxiety may contribute to this variation, although how much it contributes is not known gender-role orientation, especially masculinity, may play a role in the development and persistence of fearfulness in children.
How many kids in the US suffer significant depression each year?
3 million
What percent of teens who have lost a friend to suicide become depressed in the 6 months following?
30%
What are the 13 synmptoms of a panic attack? How many need to be seen in order in order for it to be classified?
4 (1) Palpitations, pounding heart, or accelerated heart rate. (2) Sweating. (3) Trembling or shaking. (4) Sensations or shortness of break or smothering. (5) Feelings of choking. (6) Chest pain or discomfort. (7) Nausea or abdominal distress. (8) Feeling dizzy, unsteady, light-headed, or faint. (9) Chills or heat sensations. (10) Paresthesias (numbness or tingling sensations). (11) Derealization (feelings of unreality) or depersonalization (being detached from oneself). (12) Fear of losing control or "going crazy." (13) Fear of dying. Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.
At what age are anxiety evident? What percent of parents report that thier kid is too nervous or anxious?
4 - 25% Younger children generally experience more anxiety symptoms than do older children, primarily about separation from parents.
What percent of kids of have SAD?
4% to 10%
how prevelent is SOC in kids with selective mutism? What other commorbidities are likley to be seen?
45-75% communication, elimination, and oppositional disorders
What is the lifetime prevalence of SOC?
6-12% abou 1/10
How many categories of anxiety disorders are there on the DSM-5? What are they? Describe each
7 Separation Anxiety Disorder (SAD) Characterized by excessive worry regarding separation from home or parents. Youths may show signs of distress and physical symptoms on separation, experience unrealistic worries about harm to self or others when separated, and display an unwillingness to be alone. Specific Phobia Characterized by severe and unreasonable fears and avoidance of a specific object or situation, for example, dogs, spiders, darkness, or riding on a bus. Social Anxiety Disorder (SOC) (Social Phobia) Characterized by a severe and unreasonable fear of being embarrassed or humiliated when doing something in front of peers or adults. Selective Mutism Characterized by a consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., school), even though the child may speak loudly and frequently at home or in other settings. Panic Disorder (PD) Characterized by recurrent, unexpected and severe panic attacks. These attacks may consist of an accelerated heart rate, shortness of breath, sweating, upset stomach, dizziness, fear of dying, and others. The individual also experiences a persistent concern or worry about additional panic attacks or their consequences, or displays a significant maladaptive change in behavior to avoid having panic attacks (e.g., avoidance of exercise or new situations). Agoraphobia Characterized by fear or anxiety about two or more situations such as using public transportation, being in open spaces (e.g., parking lots, marketplaces), being in enclosed spaces (e.g., theaters), being in a crowd, or being outside of the home alone. The fear or anxiety about these situations occurs because the individual thinks that escape might be difficult or help not available if they were to develop panic-like or other incapacitating symptoms. Generalized Anxiety Disorder (GAD) Characterized by ongoing and excessive worry about many events and activities. Youths may worry about their grades in school, their relations with peers, and their own or others' safety. They may constantly seek comfort or approval from others to help reduce their worry.
until when do all children experience separation anxiety?
7 months through the preschool years, almost all children fuss when they are separated from their parents or others to whom they are close a lack of separation anxiety at this age may suggest insecure attachment or other problems
What percent of youth who commit suicide recieve treatment prior?
7%
At what age are kids earliest referred with SAD?
7-8 years
What is the average age of onset for OCD?
9 to 12 years with two peaks, one in early childhood and another in late adolescence/early adulthood
What proportion of youth with depression show impairments in their daily functions?
90% - most - significant
What are the IS PATH WARM warning signals for suicide?
I Ideation S Substance Abuse P Purposelessness A Anxiety T Trapped H Hopelessness W Withdrawal A Anger R Recklessness M Mood Changes
What are 5 psychaitric disorders that 90% of people who die by suicide tend to have? Which is most often found in youth suicide?
Major Depressive Disorder Bipolar Disorder, Depressive phase Alcohol or Substance Abuse**** Schizophrenia Personality Disorders such as Borderline PD
What is depression according to lecture? How does it present in children?
A pervasive unhappy mood disorder More severe than the occasional blues or mood swings everyone experiences Children who are depressed cannot shake their sadness - interferes with their daily routines, social relationships, school performance, and overall functioning Often accompanied by anxiety or conduct disorders Often goes unrecognized and untreated
According to the DSM-5 what are the diagnostic criteria for Specific Phobia?
A) Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging. (B) The phobic object or situation almost always provokes immediate fear or anxiety. (C) The phobic object or situation is actively avoided or endured with intense fear or anxiety. (D) The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context. (E) The fear, anxiety, or avoidance is persistent, typically lasting 6 months or more. (F) The 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 accounted for by 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 (as in obsessive- compulsive disorder); reminders of traumatic events (as in post-traumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).
What is the new depressive disorders in DSM-5? Describe it. How does it relate to children?
Disruptive Mood Dysregulation Disorder is a new disorder that reflects persistent irritability and frequent episodes of extreme behavioral dyscontrol in the form of temper tantrums in children, who in the past would have been (often erroneously) diagnosed with bipolar disorder.
What are the 4 things treatment of anxiety is directed at modifying?
Distorted information processing Physiological reactions to perceived threat Sense of a lack of control Excessive escape and avoidance behaviors
When treating someone for anxiety is it best to tell them to jsut stry and not think about it?
Don't tell what not to thinking about because makes think about - instead make realize how dumb it is - ask what's the worst that could happen
do parents cause anxiety disorders?
Parents don't typically cause anxiety disorder - are perpetuating factor (eg encourages not to join team beucase socially anxious or brings purell for ocd child)
What is psychosocial treatment? who founded it?
Dr. Maurice Bucke - a founding medical director of both Asylum for the Insane in Hamilton and London (London superintendent 1877-1902d). The first professor of nervous and mental diseases at Western - 1882. Have found evidence to support sleep, diet, exercise, gainful employment, laughter, cognitive therapy, gratitiude are related to mental health
Which has a higher link to depression - school performance or social dysfunctions?
In general, the association between depression and school difficulties is not as strong as the association between depression and social dysfunction
What happens to depression and anxiety in boys and girls in teenage years?
In teens anxiety and depression goes way up in girls - not boys
What is Anaclitic depression?
Infants raised in a clean but emotionally cold institutional environment showed depression-like reactions, sometimes resulting in death Similar symptoms can occur in infants raised in severely disturbed families
What is the labelling thinking trap?
Sometimes we talk to ourselves in mean ways and use a single negative word to describe ourselves. This kind of thinking is unhelpful and unfair. We are too complex to be summed up in a single word
Who are likley to have the highest and lowest self-serving attribution biases?
Young children and old adults have strong self-serlving bias - americans are most likely - Asians lowest bias Those with depression low self-selrving bias
What is an attential bias?
Tend to selectively look for negative (eg talk about 1 plane crash in 2017) and avoid talk about positive (eg 10 000's planes haven't crashed this year)
What is the 'with mixed features 'specifier when diagnosing BP?
can be used when a current manic or hypomanic episode includes subthreshold symptoms of depression or dysthymia or when an episode of MDD includes subthreshold symptoms of mania or hypomania
What percent of those with BP experience thier first episode prior to 19?
About 60% - peak age of onset between 15 and 19 years onset prior to age 10 is extremely rare. youth with BP may first present with either depressive or manic episodes, although most report that their first mood episode was major depression. This is consistent with the reported high rates of switching from depression to mania
Describe the psychodynamic thoery of depression
Actual or symbolic loss of love object (e.g., caregiver) that is loved ambivalently; anger toward love object turned inward; excessive severity of the superego; loss of self-esteem Depression is presumed to result from the loss of a love object (e.g., mother). This loss can be actual, as in the case of the death of a parent, or symbolic, as a result of emotional deprivation, rejection, or inadequate parenting. - individual's subsequent rage toward the love object is then turned against the self fact that depression does occur in many youngsters who do not experience loss or rejection—and doesn't occur in many children who do—casts doubt on the psychodynamic model
How do help seeking behaviours for ethinic minorities differ with regards to anxiety?
African American parents who need help with their child's OCD symptoms may be more likely to turn to members of their informal social network, such as clergy or medical personnel, than to mental health professionals Their family members are also less likely to be drawn into the child's OCD symptoms. Although ethnicity is not related to outcomes in the treatment of anxiety disorders, it may be related to premature termination of treatment
In order to avoid a negative mental effect what should happen after a child experiences a tradegy?
After tradegy - best to go back to normal daily living - once tradegy over get back into routine - longer keep out of routine more likely to think something wrong, get scared, think will happen again Routine is comforting for everyone every age
When are kids most likley to first attempt suicide? Why?
Ages 13 and 14 are peak periods for a first suicide attempt by youngsters with depression. Suicide prior to puberty is rare, most likely because depression and substance abuse before pu
What is the behavioural therapy treatment of depression?
Aims to increase behaviors that elicit positive reinforcement and to reduce punishment from the environment. May involve teaching social and other coping skills, and using anxiety management and relaxation training. maintains that depression results from and is sustained by a lack of reinforcement due to a restricted range of potential reinforcers, few available reinforcers, or inadequate skills for obtaining rewards
Where on the fearometer should you start a child? How do childrens rates tend to change? what is this called?
Always start between 5-7 (not too good - pretty tough)- start at 8-10 will just refuse - 50% rule - child usually rates as 50% worse than actually is for them
How do Native American children's anxiety comapre to white children?
American youths in Appalachia (mostly Cherokee) indicate rates of anxiety disorders similar to those for white youths, with the most common disorder for both groups being SAD. Rates of SAD were slightly higher for Native American youths, especially girls
Why is early treatment for depression in youth so important?
An early onset of depression places youngsters at greater risk for experiencing multiple episodes of major depression throughout their lives. Therefore, it is critical that treatment begin as soon as possible; very early and aggressive intervention is warranted to reduce the length of a depressive episode, reduce the likelihood of future episodes, minimize associated impairments in functioning, and reduce the risk of suicide
What are the 5 types of specific phobias discussed in the DSM-5?
Animal (e.g., spiders, insects, dogs) Natural environment (e.g., heights, storms, water) Blood, injection, injury (e.g., needles, invasive medical procedures) Situational (e.g., airplanes, elevators, enclosed places) Other (e.g., situations that may lead to choking or vomiting; in children, loud sounds or costumed characters)
What is the investment policy of anxieties?
Anxieties yield at a negative rate, increasing in smallness the longer they wait.
Can BP in children be diagnosed prepuberty?
At the center of the controversy is whether BP can be diagnosed in prepubertal children. Some clinicians avoid the use of this label entirely, and instead label young children who display unstable moods with the less stigmatizing categories of ADHD or depression. Others use the label of BP liberally in young children, often based solely on the presence of mood swings, irritability, and aggression, leading to concerns about overdiagnosis. Thus, clinicians presented with identical diagnostic information vary widely in their assessment of BP in children, from 0% risk to 100% risk
What is an at least statement? What's wrong with this?
At least statements invalidate - eg I had a miscarriage - at least you know you can get pregnant - in empathy you validate
What are some of the behavioural symptoms of anxiety?
Avoidance Crying or screaming Nail biting Trembling voice Stuttering Trembling lip Swallowing Immobility Twitching Thumb sucking Avoidance of eye contact Physical proximity Clenched jaw Fidgetin The overwhelming urges that accompany the fight/ flight response are aggression and a desire to escape the threatening situation, but social constraints may prevent fulfilling either impulse may show up as foot tapping, fidgeting, or irritability (consider the number of teeth marks in pencils) or as escape or avoidance by getting a doctor's note, requesting a deferral, or even faking illness.
How are BP episodes different from depressive episodes?
Bipolar episodes are generally shorter than major depressive episodes, lasting from 4 to 6 months if left untreated. About 70% of adolescents recover from their initial episode within 6 months, but 50% will have at least one recurrent episode
Why has BP in youth become very controversial?
BP in young people is difficult to identify because it occurs infrequently, shows extreme variability of clinical presentation within and across episodes, and overlaps in symptoms with more common childhood disorders such as ADHD and conduct problems
What causes BP?
BP is the result of a genetic vulnerability combined with environmental factors, such as life stress or a negative family climate. When an identical twin has BP, there is only a 65% chance that the other twin will have it too, suggesting that in addition to genes, other factors are important. Although BP can affect anyone, it has definitely been shown to run in families
How long after first episode is BP normally diagnosed? Why?
Because it is difficult to recognize symptoms of BP in young people, the symptoms are commonly noticed well before a youngster is treated or hospitalized, but they are not labeled as BP A look back at the histories of adults with BP symptoms often shows that mood swings began around puberty; however, there is frequently a 5- to 10-year lag between the onset of symptoms and display of the disorder serious enough to be recognized and treated
Does effective psychotherapy involved exploring childhood memories?
Best evidence for treating mood and anxiety disorders (EBT) indicates: focus on the present learn skills, face fears, change thoughts, practice new behaviours daily. (Exception - PTSD we expose the person to the fear memory also).
What is the best way to show you're listening to someone?
Best way to show you're listening is to repeat back to them - can reflect content or feeling - have to know when to do which
What have brain scans of children with BP found? Which areas of the brain have been implicated?
Brain scans of children identified as being at risk for BP that were taken before and after the onset of a manic episode have shown changes in the brain that reflect a pattern of emotion dysregulation in general, rather than one that is specific to BP onset mood fluctuations in BP have been related to abnormalities in the structure and function of the amygdala, prefrontal and anterior cingulate cortex, hippocampus, thalamus, and basal ganglia, but findings have not always been consistent with respect to the types of abnormalities Some studies have found that BP in adolescents is related to reduced volumes of the amygdala and hippocampus youth with BP misread neutral facial expressions as hostile and in doing so show heightened activation of the amygdala and its connectivity to other parts of the brain involved in processing facial information - uggest that youths at risk for and those with BP may display unique neural correlates and deficits in facial emotion processing and dysregulation in brain regions associated with emotion regulation
What are the 3 processes in the coping toolkit?
Breathing Strategies Triangle Breathing Relaxation Progressive Muscle Relaxation Yoga, stretching Self Talk Coping thoughts Identifying thinking errors You do need to feel some anxiety to "face" and conquer fear
What is up and down the worry hill?
CBT manualized treatment Includes a child friendly book and therapist treatment guide First I externalize OCD - the child gives it a bad or silly name for everyone in the family to know who is causing the problem Then you can practice ERP, and direct the family to disengage from compulsive scripts exposure = climbing hill - top = peak anxiety - begin to come down when habitutation though exposrure - if escape at peak have to start again sometimes due to heightened physiology habituation never occurs and person needs meds
What is the primary treatment for OCD?
CBT that helps them learn to confront their worst fears gradually (graded exposure) while being prevented from engaging in their rituals (response prevention) Family treatment for OCD provides education about the disorder and helps families cope with their feelings, such as helplessness in not being able to relieve the child's pain, frustration that the child cannot "just stop," jealousy from siblings, and disappointment that the child is not "normal"
Is the onset of depression in teens gradual or sudden? When do adults with deporession tend to have thier first episode?
Can be either - Either way, a youth typically has a history of milder episodes of depression that do not meet DSM-5 diagnostic criteria. Most adults with depression recall having their first depressive episode between the ages of 15 and 19 - prospective studies of children and adolescents usually find earlier ages at onset, most commonly between the ages of 13 and 15
According to lecture, how should parents respond to SAD?
Can get worse if give into it - Always send them TO SHOOL unless actual feaver - even if throw up
According to lecture, what are the 5 steps of a therapy session? ci pe w p co
Check-in: informed consent, review of goals, personal updates, review of homework sheets Psychoeducational teaching (EBT!) In session modelling, practice and guided rehearsal "First we do some work, then we will do some play". New homework discussed and practiced in sessions Now play time that was agreed upon Check-out: Homework sheets given - practicalities and obstacles? Formal check of therapeutic alliance - still on track, goal attainment? Hearing you?
What is anxious vigilance and what is another name for this?
Children at risk for anxiety and those with anxiety disorders selectively attend to information that may be potentially threatening or dangerous (e.g., an angrylooking face)—a tendency referred to as anxious vigilance or hypervigilance more severe the children's anxiety, the stronger is their attention to potentially threatening stimuli
How likely are children with parents who are depression to get depression compared to those who don't? What are disturbances are children with depressed parents likely to show?
Children of parents with depression have about 3 times the risk of having depression as compared with children of parents with no psychiatric disorders risk for depression is even higher when both parents have a mood disorder. Children of depressed parents also have an earlier age at onset for their depression (by about 3 years of age) and are more likely to show an onset before puberty than children of nondepressed parents children of depressed parents also display a variety of other emotional and behavioral disturbances, including anxiety, conduct problems, and substance-use disorders
What is an anxiety disorder?
Children who experience excessive and debilitating anxieties are said to have occur in many forms.
How does age of onset compare with children who have anxiety and depression compared to just anxiety?
Children with anxiety and depression have an older age at presentation than children with only anxiety, and in most cases symptoms of anxiety both precede and predict symptoms of depression are increasingly distinct in older children and children with at least one diagnosable disorder
What is cognitive behaviour therapy?
Cognitive activity affects behaviour Cognitive activity may be monitored and altered Desired behaviour change may be affected through cognitive change Thoughts effect behaviour - can be difficult to change behaviour - maybe work on changing thoughts - Not working on feelings This term encompasses treatments that attempt to change overt behaviour by altering thoughts, interpretations, assumptions, and strategies of responding
What is the prevelence of commorbid disorders with OCD? What si the most common disorder? What are some others?
Comorbid disorders are common, occurring in about 50% of children in community samples, and the rates are much higher in children in clinic samples most common comorbidities are anxiety disorders, ADHD, ODD, and vocal and motor tics, which usually improve or remit in the second decade of life. As the child gets older, depressive disorders, substance-use disorders, learning disorders, and eating disorders are also overrepresented in children with OCD
What is selective mutism? What does it interfere with? How long does it half to last before considered a disorder? How long does it usually take to see someone?
Consistent Failure to Speak in Specific Situations despite speaking in other situations Interferes with: Educational or Occupational Achievement Social Communication Not due to : Speech or Language Disorder, Autism Knowledge of Language (e.g., ESL) One Month Duration - usually don't see for 3 months
Are psychotherapists paid friends?
Due to the power differential in the therapeutic alliance, NO dual relationships are allowed (financial, sexual, personal) by members of a regulated health profession and a patient Clear rules are set to ensure no boundaries are violated. Regulated health professions in Ontario are defined by legislation, known as the Regulated Health Professions Act (RHPA) Dual role - when therapist and also another role in life eg friendship - not allowed - inappropriate Just now starting to register psychotherapist and psychotherapy - before anyone could call
What is the Interpersonal Psychotherapy for Adolescent Depression (ITP-A) treatment of depression?
Explores family and interpersonal interactions that maintain depression. Family sessions are supplemented with individual sessions in which youngsters with depression are encouraged to understand their own negative cognitive style and the effects of their depression on others and to increase pleasant activities with family members and peers
How can the negative effects of maternal depression be buffered?
Regulated early child-care services may also help to buffer the negative effects of maternal depression on children's internalizing problems
When was DMDD introduced to the DSM? How much do we know about it?
DMDD is a new depressive disorder in DSM-5, and it is the one that we know the least about.
How do cognitive-behavioural prevention programs for depression work? Do they work?
Depressed parents and their children are taught a wide array of problem-solving and coping skills, including teaching children ways of coping with their parent's depression. The goals of the program are to educate families about depression, to increase awareness of the impact of stress and depression on functioning, to help families recognize and monitor stress, to facilitate the use of effective ways of coping with stress, and to improve parenting Those who received the intervention showed significantly lower rates of MDD over a 2-year period, significantly lower rates of internalizing and externalizing symptoms at 18 months, and significantly lower rates of externalizing symptoms at 24 months. Marginal effects were found for reductions in parents' symptoms of depression at 18 and 24 months but not for episodes of MDD
How is the symptom of depression different from the syndrome and a disorder?
Depression (symptom): feeling sad or miserable Occurs without existence of serious problem, and is common at all ages Depression (syndrome): a group of symptoms that occur together more often than by chance Mixed symptoms of anxiety and depression that tend to cluster on a single dimension of negative affect Depression (disorder) Major depressive disorder (MDD): Has a minimum duration of two weeks Is associated with depressed mood, loss of interest, and other symptoms; and significant impairment in functioning
Why was it previously thought that children didn't experience depression?
Depression in children is not masked, but rather may be overlooked It frequently co-occurs with other more visible disorders
According to the DSM-5 what are the two general categories mood disorders can be divided into?
Depressive disorders excessive unhappiness (dysphoria) and loss of interest in activities (anhedonia) Bipolar disorder mood swings from deep sadness to high elation (euphoria) and expansive mood (mania)
Describe the cognitive theory of depression. What are depressogenic cognitions and hopelessness theory?
Depressive mindset; distorted or maladaptive cognitive structures, processes, and products; negative view of self, world, and future; poor problem-solving ability; hopelessness underlying assumptions are that how young people view themselves and their world will influence their mood and behavior and that cognitive vulnerabilities interact with negative events to increase depressive symptoms. Cognitive theories emphasize depressogenic cognitions, which are the negative perceptual and attributional styles and beliefs associated with depressive symptoms. hopelessness theory proposes that depression-prone individuals tend to make internal, stable, and global attributions to explain the causes of negative events. In other words, when something bad happens, they think that they are responsible (internal attribution), that the reason they are to blame will not change over time (stable attribution), and that the reason that something bad happened applies to most things they do and in most situations (global attribution)
What are the two types of social phobias?
Different from making small talk at a party than giving lecture
What tends to be the effect of early childhood stress?
Early life stress may also produce lasting hyperreactivity of corticotropin-releasing factor (CRF) systems, which are closely related to the HPA axis, as well as alterations in other neurotransmitter systems that create a heightened response to stress
What is dsicussed in the text as a succful prevention program for depression in youth?
Early studies of prevention with grade school and high school students with subclinical symptoms of depression found CBT/problem-solving approaches to be effective in reducing depressive symptoms and lowering the risk for developing depression up to 2 years after treatment not all programs have reported benefits. For example, in a later controlled study, a comprehensive school-based program for adolescents attempted to develop individual resiliency skills and enhance protective factors in the environment.
According to lecture what are the 5 ways to prevent suicide within a community? E S T MR MG
Education Screening Treatment Means Restriction Media Guidelines
What is the 4 step fear plan according to the coping cat program?
F = Feeling frightened? (recognizing physical symptoms of anxiety) E = Expecting bad things to happen? (recognizing anxious cognitions) A = Attitudes and actions that will help (coping self-talk and behavior to use when anxious) R = Results and rewards (evaluating performance and administering self-reward for effort) second part of the program is devoted to exposure and practice. Children attend 16 to 20 sessions over a period of 8 weeks
Why is constantly facing your fears important to getting rid of anxiety?
Facing your fears is hard work Avoidance increases fear, bodily feelings and thoughts of dread will naturally go away with graduated, repeated exposure Celebrate each success!
What is the difference between empathy and sympathy?
Empathy fuels connections - sympathy separation
For which disorders is CBT most and leaste ffective?
Evidence suggests that children with SAD and GAD may show more favorable outcomes than those with SOC
When should anxiety be treated? 3
Excessive Developmentally inappropriate for the individual's age Causing significant impairment in the individual's life
How is anxiety distinct from fear and panic?
Fear is a present-oriented emotional reaction to current danger marked by a strong escape tendency and an all-out surge in the sympathetic nervous system. The overriding message is alarm: "If I don't do something right now, I might not make it at all." In contrast, anxiety is a future-oriented emotion characterized by feelings of apprehension and lack of control over upcoming events that might be threatening. Fear and anxiety both warn of danger or distress. However, only anxiety is frequently felt when no danger is actually present Panic is a group of physical symptoms of the fight/ flight response that unexpectedly occur in the absence of any obvious threat or danger. With no explanation for physical symptoms such as a pounding heart, the child may invent one: "I'm dying." The sensations themselves can feel threatening and may trigger further fear, apprehension, anxiety, and panic
What are some common fears from 5-7 years? What are related anxiety disorders?
Fear of specific objects (animals, monsters, ghosts) — Specific phobias Fear of germs or of getting a serious illness — Obsessive-compulsive disorder (OCD) Fear of natural disasters, fear of traumatic events (e.g., getting burned, being hit by a car or truck) — Specific phobias (natural environment), acute stress disorder, post-traumatic stress disorder, generalized anxiety disorder
What are some common fears from 2-3 years? What are possible symptoms and related anxiety disorders?
Fears of thunder and lightning, fire, water, darkness, nightmares Crying, clinging, withdrawal, freezing, avoidance of salient stimuli (e.g., turning the light on), night terrors, enuresis Specific phobias (natural environment), panic attacks also - fears of animals - can have speicifc animal phobias
What is the fear acronym from the coping cat program?
Feeling frightened? Expecting bad things to happen? Attitudes and Actions Results and Rewards
What proportion of children with depression get help? What is the most succesfful form of treatment for depression?
Fewer than half of children with depression receive help for their problem Rates vary by racial/ethnic background Cognitive-behavioral therapy (CBT) Has shown the most success in treating children and adolescents with depression
How is anxiety related to the sympathetic response system?
Fight/flight/freeze (sympathetic) response Immediate reaction to perceived danger or threat aimed at escaping potential harm when anxiety threat isn't actually there
How is SAD related to PD?
Findings generally support SAD as a strong predictor of PD. However, since SAD also predicts other anxiety disorders (but not depressive or substance-use disorders), it may be an early marker for anxiety disorders in general, rather than a specific risk factor for PD
According to the socioenvironmental models of depression what are the 4 ways in which stressful life events?
First, depression can be a direct reaction to the occurrence of stressful life events, such as the loss of a parent. Second, the impact of stress may be moderated by individual risk factors, such as genetic risk. This is referred to as the diathesis-stress model of depression because the occurrence of depression depends on the interaction between the youngster's personal vulnerability (diathesis) and life stress. Third, negative environmental events may be internalized as negative cognitive styles (e.g., rumination), which then predispose the child to depression. Finally, depression may result in behaviors and impairments in functioning that generate stressful life circumstances that in turn lead to depressive reactions
What are the two lines of evidence that suggest anxiety disorders run in families?
First, parents of children with anxiety disorders have increased rates of current and past anxiety disorders Second, children of parents with anxiety disorders have an increased risk for having anxiety disorders themselves
What are the three areas depressed individuals show cognitive problems?
First, they display information-processing biases, or errors in their thinking in specific situations, called negative automatic thoughts. These often include thoughts of physical and social threat, personal failure, and hostility. They may selectively attend to negative information, assume blame for negative events, maximize and exaggerate negative events, and minimize positive events. They also assign negative labels to events and then react emotionally to the label rather than to the event. For example: ▲ EVENT: Child didn't receive an invitation to Ashley's party. ▲ LABEL: "I didn't receive an invitation because Ashley doesn't like me. Nobody likes me." ▲ EMOTIONAL REACTION: Unhappiness and depression. Second, depression is believed to be associated with a negative outlook in the following three areas, referred to as the negative cognitive triad ▲ Negative views about oneself (e.g., "I'm no good," "I'm boring") ▲ Negative views about the world (day-to-day experiences) (e.g., "They're no good," "It's too hard") ▲ Negative views about the future (e.g., "It's always going to be this bad," "I'll never graduate") These negative views become increasingly more stable with age, maintain feelings of helplessness, undermine the youngster's mood and energy level, and are related to the child's severity of depression depressed youngsters have negative cognitive schemata, which are stable structures in memory that guide information processing, including self-critical beliefs and attitudes. These schemata are rigid and resistant to change even in the face of contradictory evidence and may heighten the youngster's sensitivity to depression, especially when activated by stress
What is the cognitive therapy treatment of depression?
Focuses on helping the youngster with depression become more aware of pessimistic and negative thoughts, depressogenic beliefs and biases, and causal attributions of self-blame for failure. Once these self-defeating thought patterns are recognized, the child is taught to change from a negative, pessimistic view to a more positive, optimistic one.
When is depression and anxiety likely to be diagnosed?
GAD, SAD, and SOC are more commonly associated with depression than is specific phobia more often in children with multiple anxiety disorders and in children who show severe impairments in their everyday functioning
Who tends to have more fears girls or boys?
Girls tend to have more fears than boys at almost every age; they also rate themselves as more fearful and report fears that are more intense and disabling than do boys. Girls display more anxiety than boys, but they generally experience similar types of symptoms. Although some specific anxieties decrease with age, such as separation anxiety and anxiety about school, nervous and anxious symptoms may not show the age-related decline observed for many specific fear
How does the hypothalamic-pituitary-adrenal (HPA)-axis relate to depression?
HPA-axis dysregulation is evidenced by abnormal cortisol responses in children and adolescents with depression, including higher baseline levels and atypical or overactive responses to stressors. HPA-axis and other neurobiological findings have led to a strong interest in the impact of early exposure to stress on later negative moods. Mounting evidence suggests that early adversity (e.g., prenatal stress, harsh or neglectful parenting) may produce HPA-axis abnormalities (e.g., alterations in corticotropin-releasing hormone [CRH] circuits), which sensitize the child to later stress, thus increasing the risk for developing depression
What is Trichotillomania?
Hair-Pulling Disorder - characterized by recurrent pulling out of one's hair, resulting in hair loss (not attributable to another medical condition),
When are the highest and lowest rates of depression?
Highest rates of suicide are in the spring, while the lowest rates are in December.
What is the likelihood of a child having BP if thier parents have it?
If one or both parents have BP, the chances are about 5 times greater that their children will also develop BP or often another recurrent mood disorder Offspring of mothers with BP are more likely to exhibit greater physiological dysregulation in response to stress than controls at as young as 6 months of age; this is a possible early vulnerability factor for later mood disorders
What is performance only SOC?
If the fear is restricted to speaking or performing in public
Describe the Interpersonal thoery of depression
Impaired interpersonal functioning related to grief over loss; role dispute and conflict; role transition; interpersonal deficit; single parenting; social withdrawal; interaction between mood and interpersonal events
What is 'teen talk'
In an effort to reach more youngsters, IPT-A is also being developed as a preventive intervention ("Teen Talk") for adolescents in grades 7 to 10 who display elevated levels of depressive symptoms. Preliminary findings suggest that IPT-A and Teen Talk may useful approaches to preventing more severe forms of depression and reducing symptoms of anxiety
What areas of the brain are found to be less active in those with depression? Where are they more active?
In general, brain activity has been found to be less active than normal in regions of the brain associated with attention, executive functions, and sensory processes, but more active than normal in regions involved in recognizing and regulating emotions, mediating stress responses, and learning and recalling emotion-arousing memories
What are some of the physical symptoms of anxiety? How do these symptoms develop?
Increased heart rate Fatigue Increased respiration Nausea Stomach upset Dizziness Blurred vision Dry mouth Muscle tension Heart palpitation Blushing Vomiting Numbness Sweating When a person perceives or anticipates danger, the brain sends messages to the sympathetic nervous system, which produces the fight/flight response
What has been found with regards to stress hormones in infants with depressed mothers?
Infants of depressed mothers show higher levels of salivary cortisol (the stress hormone) and less relative left frontal lobe electrical activity than infants of mothers without depression Infants of depressed mothers show higher levels of salivary cortisol (the stress hormone) and less relative left frontal lobe electrical activity than infants of mothers without depression may be a vulnerability factor for negative emotional states and later onset of depression, although not all studies support this finding
How do you decide who to get consent from for treatment?
Inform the client of benefits and risks and how likely the treatment outcome research applies to their situation Capacity to consent to tx is not based on age in Ontario Health Care Consent Act says anyone with the capacity to understand the risks and benefits and has the capacity to appreciate the consequences, makes the decision about their own health care If they can not understand or appreciate the informed consent discussion - then a Substitute Decision Maker signs consent to treatment (e.g., parent/guardian) CBT strategies have good ES in children with low risk, but a percentage do not seem to respond - factors?
What are the 9 things the Adolescent Coping with Depression Program (CWD-A) focuses on?
Initially, adolescents learn that depression can have many causes, including inherited tendencies, stress, and excessive negative thinking. Relaxation training is then used to quickly provide a successful experience and some immediate relief. ▲ Self-change skills, such as self-monitoring of mood and behavior, and ways to establish realistic goals, are taught. ▲ Pleasurable activities and opportunities for reinforcement are increased. ▲ Positive thinking is increased by identifying, challenging, and changing negative cognitions. ▲ Training in social, communication, and problemsolving skills is integrated throughout the program. ▲ Specific skills are taught, such as conversational skills, ways to plan social activities, and ways to make friends. ▲ Goal setting is used to identify short- and long-term life goals and potential barriers to these goals. ▲ Final sessions emphasize integrating the skills learned and making plans for the future.
How is attachment related to anxiety?
Insecure attachments may be a risk factor for the development of later anxiety disorders and are associated with anxiety disorder symptoms in early adolescence . Mothers with anxiety disorders have been found to have insecure attachments, and 80% of their children are also insecurely attached This relationship may be mediated by the impact of the mother's anxiety on her sensitivity to her child ambivalently attached have more anxiety diagnoses during childhood and adolescence than infants who are securely attached It may be a risk factor, but insecure attachment may be a nonspecific factor because many infants with insecure attachments develop disorders other than anxiety
Describe the attachment thoery of depression
Insecure early attachments; distorted internal working models of self and others A parent's consistent failure to meet the child's needs is associated with the development of an insecure attachment, a view of the self as unworthy and unloved, and a view of others as threatening or undependable. These factors may place the child at risk for later depression, particularly in the context of stressful interpersonal relationships a secure attachment may help to reduce distress, whereas an insecure attachment may lead to difficulties in regulating emotion, which in turn may become a risk factor for later depression. In support of this theory, children with insecure attachments are more likely than children with secure attachments to display symptoms of depression children and adolescents with depression are more likely to experience disturbances in attachment than are children without depression. In one study, only 8% of adolescents with depression were securely attached (vs. 52% of controls), and 40% of them had an insecure attachment that was unresolved with regard to loss or abuse
What is a common fear within the first 0-6 months?
Intense sensory stimuli (loud noises
What are the 3 typesof attribution? what do they mean? which dp therapists aim for? why?
Internal/external - cause by self or outside self stable/unstable - can change or not controllable/uncontrollable - you can change or not Internal-unstanble- controllable best bc increases effort bc can change - effort attribution
Describe the behavioural thoery of depression
Lack or loss of reinforcement or quality of reinforcement; deficits in skills needed to obtain reinforcement Depression is related to a lack of response-contingent positive reinforcement lack of positive reinforcement may occur for three reasons: First, a youngster may be unable to experience available reinforcement, often because of interfering anxiety. Second, changes in the environment, such as the loss of a significant person in the child's life, may result in a lack of availability of rewards. Finally, a youngster may lack the skills needed to have rewarding and satisfying social relationships Children may also receive sympathy for their sadness, which produces the desired attention and concern.
What are 2 common fears within the first weeks of life?
Loss of physical support, loss of physical contact with caregiver
How does birth weight relate to depression?
Low birth weight has been found to predict depression in adolescent girls but not in adolescent boys, and girls born at a low birth weight are especially vulnerable to adversity after puberty - suggests that low birth weight may be a marker for poor intrauterine conditions that lead to adjustments in fetal development, which in turn have long-term consequences for girls' response to stress in adolescence.
What is behaviuor therapy for anxiety? What is the main technique? What are systematic desensitization, flooding, response prevention, adn graded exposure?
Main technique - is exposure to feared stimulus while providing children with ways of coping other than escape and avoidance Graded exposure: gradual exposure using Subjective Units of Distress Scale (SUDS from 1 to 10) and beginning with least distressing stimulus Systematic desensitization: teaching child to relax, constructing anxiety hierarchy, presenting anxiety-provoking stimuli while child remains relaxed not used often anymore as exposure and time to habituate seems to be the key factor to treatment success Flooding: prolonged repeated exposure Response prevention: prevents child from engaging in escaping or avoidance stimuli Modeling and reinforced practice; in vivo (real world) exposure works best (don't just talk, do it).
Do people who talk about suicide tend to complete suicide?
Many people who die by suicide have given definite warnings to family and friends of their intentions. Always take any comment about suicide seriously.
What is agoraphobia? What are the 5 situations in which in occurs?
Marked fear or anxiety about two (or more) of the following five situations: (1) Using public transportation (e.g., automobiles, buses, trains, ships, planes). (2) Being in open spaces (e.g., parking lots, marketplaces, bridges). (3) Being in enclosed spaces (e.g., shops, theatres, cinemas). (4) Standing in line or being in a crowd. (5) Being outside of the home alone. The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence).
Why is medication use for anxiety tricky? What type of medication shouldn't be used? What should eb used?
Medication second line treatment after cognitive behavioural therapy If don't feel any anxiety CBT won't work - need to actually be exposed and feel the anxiety and show can cope Don't use benzodiaphine (sp?) aka vallium not used - takes away any concern at all - won't overcome anxiety at all Some people need vallium to cope - fine as long as not life long - need to increase dose overtime to keep working - becomes addictive SSRI don't change dosage at home - can't take yourself off it
Why do we need more focus on psychosocial treatments of bp? What are they?
Medications may decrease symptoms of BP, but they do not help with the associated functional impairments or preexisting or co-occurring substance-use disorders, learning and behavior problems, and family- and peer-related issues. Nonadherence to medication regimens has been shown to be a major contributor to relapse. focus on providing information to the child and family about the disorder, symptoms and course, possible impact on family functioning, and heritability of the disorder. Youths and parents are also taught ways of coping with symptoms and preventing relapse by using problem-solving, communication, emotion regulation, and cognitive—behavioral skills
Are men or women more likely to be suicidal?
Men are four times more likely to kill themselves than women. Women attempt suicide three times more often than men do.
What is the best way to do mindfulness trainging?
Mindfulness training about staying the moment - can be very difficult - best way to do is to focus on 5 senses
What are the 5 aspects of the multimodal plan for bipolar treatment?
Monitoring symptoms closely Educating the patient and the family Matching treatments to individuals Administering medication, i.e. Lithium Addressing symptoms and related psychosocial impairments with psychotherapeutic interventions
What percent of youth with BP also have an anxiety disorder? What has been found with the effects of these disorders on BP?
More than 60% as many as 50% have two or more anxiety disorders. morbid anxiety disorders have been found to adversely affect the course of BP in young people, suggesting the need for early recognition and treatment
How can children with OCD be so reasonable about some things yet so disturbed with respect to their obsessions and compulsions?
Most children over age 8 persist in their obsessions or compulsions even though they recognize them as excessive and unreasonable (children ordinarily use the words dumb or stupid). However, OCD is extremely resistant to reason, even when the child recognizes the "silliness" of the routines.
Is school refusal mostly by those with low IQ?
Most children who refuse to go to school have average or above-average intelligence, suggesting that it is not a difficulty with academics that leads to this problem
Where do most anxiety interventions begin?
Most interventions begin with education. This includes explaining what anxiety is at a physiological level, and how it effects our thoughts, feelings, and behaviours For young children, normalize age appropriate fears and our ability to be brave by reading books
Are suicidal people intent on dying? What is this called?
Most suicidal people are undecided about living or dying, which is called "suicidal ambivalence." A part of them wants to live; however, death seems like the only way out of their pain and suffering. They may allow themselves to "gamble with death," leaving it up to others to save them.
Does improvement following a suicide attemmpt or crisi mean that the risk is over?
Most suicides occur within days or weeks of "improvement," when the individual has the energy and motivation to actually follow through with his/her suicidal thoughts. The highest suicide rates are immediately after a hospitalization for a suicide attempt.
When do we start to see selective mutism? Why can this problematic?
Mostly at school entry Waiting longer to diagnose - eg teacher saus just shy I'll get them talking - makes worse bc becomes part of personality
What two skills are essential to treating GAD?
Relaxing and focusing mind
What are Jeff's 6 General Principles of treatment? W ctf g h m l
Need a client motivated to change - what if their parent drags them to see me? Nonspecific or common therapy factors can determine outcomes - therapeutic relationship factors. Need clearly defined goals that are agreed upon by all and are SMART. 4. Need to do homework outside of the session to practice those goals through new behaviour. 5. Need to monitor goal attainment - tools to measure change and alliance over time. 6. Need to follow the specific intervention factors found in Evidence Based Treatment (EBT) literature - just chatting about feelings does not change behaviour
Why is treating gad more difficult that specific phobias?
Need to teach how to relax - can't use exposure therapy to remove
What are negative and positive affectivity?
Negative affectivity is a persistent negative mood, as reflected in nervousness, sadness, anger, and guilt. In contrast, positive affectivity refers to a persistent positive mood that includes states such as joy, enthusiasm, and energy. Negative affectivity is related to both anxiety and depression, whereas positive affectivity is negatively correlated with depression but is independent of anxiety symptoms and diagnoses
Describe the neurobiological thoery of depression
Neurochemical and receptor abnormalities; neurophysiological abnormalities; neuroendocrine abnormalities; genetic variants; abnormalities in brain structure and function; effects of early experience on the developing brain
How does OCD in girls compare to boys?
OCD is about twice as common in boys as in girls. However, this gender difference has not been observed in community samples of adolescents, which may be a function of age differences, referral bias, or both
What are obsessions and compulsions?
Obsessions = thoughts Compulsions = behaviours - generally used to reduce anxiety caused by obsessions
How can panic attacks be induced? Why would you do this?
Often think had panic attack - actually have anxiety attack - haven't had the associated physiological responses Can induce by having some breathing deep fast - can used to determine if actually had Breathing into bag reduces oxygen - same as taking slow deep breaths bc reduced oxygen going in
When does SAD normally occur?
Often, SAD occurs after a child has experienced major stress, such as moving to a new neighborhood, entering a new school, death or illness in the family, or an extended vacation.
What is the pills and skills method of treatment?
Once medication stops, benefits stop Generally, we recommend a youth work on skill development and alter their behaviour (e.g., behavioural activation) and challenge negative thoughts (CBT). If they can not muster the energy to do so, or they are at high risk due to hopelessness, then we recommend pills + skills.
How does SES and parents interact to affect anxiety?
Parental anxiety disorder alone may not lead to an elevated risk of anxiety disorders in children of high- or middle-SES parents, but it may increase risk in children of low-SES parents some children have a genetic vulnerability to anxiety, which may be actualized in the context of specific life circumstances, such as the stressful conditions that are often present in low-SES families Children with an initial disposition to develop high levels of fear may be especially vulnerable to the type of power-assertive parenting often used by low-SES parents. These children may be particularly sensitive to punishment and, when exposed to physical discipline, may become hypervigilant to hostile cues and develop a tendency to react defensively or aggressively
What is the Adolescent Coping with Depression Program (CWD-A)?
One of the most well-established and comprehensive CBT programs for the treatment of depression in adolescents nonstigmatizing psychoeducational approach that emphasizes skills training to promote adolescents' control over their moods and enhancement of their ability to cope with problematic situations. Treatment is provided in 16 two-hour sessions over an 8-week period for groups of up to 10 adolescents ages 13 to 18. Adolescents use a workbook that includes brief readings, short quizzes, structured learning tasks, and forms for homework assignments for each session. The core treatment sessions with adolescents involve group activities and role playing. In addition, complementary therapy with the youngsters' parents is carried out to accelerate and support the learning of new skills, and to assist in applying the skills learned in the group to everyday life situations. Periodic "booster sessions" help to maintain the skills taught during treatment
What is the relation between maternal depressogenic cognitive style during pregnanacy?
One study found an association between a maternal depressogenic cognitive style during pregnancy and offspring cognitive style 18 years later. How and when does a cognitive vulnerability for depression interact with stress to result in depression
What is the remission rate like for agoraphobia and pd?
PD and agoraphobia are stable over time and have one of the lowest complete remission rates for any of the anxiety disorders In the absence of treatment, these disorders are likely to have a persistent and chronic course.
According to lecture, what are the perpetuating, predisposing, and precipitating conditions of family risk factors for depression?
PERPETUATING CONDITIONS (Unchangeable) Family history of suicide, mental illness, substance abuse Race Gender Genetics PREDISPOSING CONDITIONS (of Serious Concern) Unrealistic parental expectations Abuse (emotional, physical, sexual) PRECIPITATING CONDITIONS (Acute) Major family conflict Exposure to suicide of family member Anniversary of death Moving often
According to lecture, what are the perpetuating, predisposing, and precipitating conditions of environmental or social risk factors for depression?
PERPETUATING CONDITIONS (Unchangeable) Inconsistent, neglectful or abusive parenting Sexual orientation PREDISPOSING CONDITIONS (of Serious Concern) Experience of repeated loss Chronic severe stress Ongoing harassment PRECIPITATING CONDITIONS (Acute) Active suicide cluster in community Access to lethal means Bullying, harassment Loss of freedom (e.g., incarceration)
According to lecture, what are the perpetuating, predisposing, and precipitating conditions of personal behaviour risk factors for depression?
PERPETUATING CONDITIONS (Unchangeable) Loss through death, abandonment, divorce PREDISPOSING CONDITIONS (of Serious Concern) Previous suicide attempt Mental illness Substance abuse Extreme Perfectionism Poor coping/social skills Impulsive PRECIPITATING CONDITIONS (Acute) Current acute Mental Illness Severe stress/anxiety Isolation Rejection Relationship break-up Increased use of substances
How can parents help with OCD?
Parent will usually have to be involved - eg parents have to open the door - only child can open microwave etc so that child not upset - encourages to persist Need to not help - parent should open microwave to show that nothing bad is going to happen
If worrying about the future is so unproductive, why do we do so much of it?
Part of the reason seems to be that the process of worry—thinking about all possible negative outcomes—serves an extremely useful function in normal development. In moderate doses, worry can help children prepare for the future
How had the hippocampus found to be related to depression?
Parts of the hippocampus are involved in recognizing the environmental contexts for reward or danger, including sensitivity to stress. Brain-scan studies have found that individual variations in hippocampal volume interact with family stress to prospectively predict differences in depressive symptoms in adolescent girls over a period of 2.5 years individuals with depression may experience a constant state of anxiety and have difficulty recognizing situations that are safe
What are some common fears from 12-18 years? What are possible symptoms and related anxiety disorders?
Personal relations, rejection from peers, personal appearance, future, natural disasters, safety Fear of negative evaluation Social anxiety disorder (social phobia) Based
What are the four parts of empathy?
Perspective taking Staying out of judgement Recognizing emotion in other Communicating that understand
Which types of phobias have onset at 7-9 years old?
Phobias involving animals, darkness, insects, blood, and injury
How does depression tend to present in preschoolers, schoolaged children, and preteens?
Preschoolers May appear extremely somber and tearful, lacking exuberance; may display excessive clinging and whiny behavior around mothers School-aged children The above, plus increasing irritability, disruptive behavior, and tantrums Preteens The above, plus self-blame, low self-esteem, persistent sadness, and social inhibition
What is agoraphobia? How is it related to panic disorders?
Prior to DSM-5, panic disorder and agoraphobia were connected because diagnosing panic disorder included the designation "with" or "without" agoraphobia (i.e., a marked fear or avoidance of certain situations in which the individual thinks that escape may be difficult, or help not available, if they were to experience panic-like or other incapacitating symptoms
Describe the self-control thoery of depression
Problems in organizing behavior toward long-term goals; deficits in self-monitoring, self-evaluation, and self-reinforcement
What are the 8 theories of depression discussed in the text?
Psychodynamic Attachment Behavioral Cognitive Self-Control Interpersonal Socio- environmental Neurobiological
How does BP effect different cultures?
Rates of BP have not been found to differ by ethnicity or culture, but few studies have investigated this issue in children and adolescents
What is a panic disorder?
Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes and during which time four (or more) of the following symptoms occur: Note: The abrupt surge can occur from a calm state or an anxious state. recurrent unexpected panic attacks followed by at least 1 month of persistent concern or worry about having another attack and its consequences or a significant change in their behavior related to the attacks in order to avoid having them
What are the two most common anxiety disorders?
SAD and specific phobia
What proportion of kids with SAD persists into adulthood? What do we tend to see in these adults?
SAD persists into adulthood for more than one-third of children and adolescents. As adults, these individuals are more likely than others to experience relationship difficulties (e.g., never marry or become separated or divorced), other anxiety disorders and mental health problems (particularly panic disorder and depression), and functional impairment in their social and personal lives
What is the most common secondary diagnosis for kids referred for anxiety disorders in general?
SOC
What are the most common medication prescribed to treat depression in youth? How does their effectiveness compare to a placebo?
SSRIs (e.g., Prozac, Zoloft, and Celexa) are the most commonly prescribed medications for treating childhood depression There is support for their efficacy; side effects can be a concern SSRIs take time to work, titration up and down in dosage must be done by a doctor Up to 60% of depressed youngsters respond to placebo
What are some common fears from 5-11 years? What are possible symptoms and related anxiety disorders?
School anxiety, performance anxiety, physical appearance, social concerns Withdrawal, timidity, extreme shyness with unfamiliar adults and peers, feelings of shame Social anxiety disorder (social phobia) Adolescence
What are some common fears from 12-18 months? What are possible symptoms and related anxiety disorders?
Separation from parent, injury, toileting, strangers Sleep disturbances, nocturnal panic attacks, oppositional defiant behavior Separation anxiety disorder, panic attacks
What are some common fears from 4-5 years? What are possible symptoms and related anxiety disorders?
Separation from parents, fear of death or dead people Excessive need for reassurance Separation anxiety disorder, generalized anxiety disorder, panic attacks
What are some common fears from 6-8 months?
Shyness/anxiety with stranger, sudden, unexpected, or looming objects
Do teens or young children tend to have more somatic symptoms?
Somatic symptoms are also more frequent in adolescents than in younger children and in children who display school refusal
When do phobias tend to peak?
Specific phobias can occur at any age but seem to peak between 10 and 13 years of age
Which type of phobia is more common in girls than boys?
Specific phobias, particularly blood phobia, are more common in girls than boys
What are the 4 steps of a fear ladder?
Steps from lowest to highest anxiety Start with manageable tasks Praise for success Console and re-evaluate if not successful
Describe the socio-environmental thoery of depression
Stressful life circumstances and daily hassles as vulnerability factors; social support, coping, and appraisal as protective factors
iS BP diagnosed before the age 18 different from adult BP?
essentially the same disorder that occurs in adults, although possible differences in longterm outcomes and associated characteristics are not known
According to lecture what is needed for an anxiety diagnosis?
TO be classified needs to be excessive and debilitating when not threat there - if there is a bear there it's not excessive - responding in maladaptive way
What is the coping cat program?
Teach child to recognize feelings Teach physiology of anxiety Teach relaxation Teach how different thoughts = different feelings = different actions Identify and replace distorted thoughts SUDS ratings Graduated Exposure therapy - Practice, Reward, Practice, Reward, Practice, Reward......
How is the amgdala related to anxiety?
The amygdala detects and organizes reactions to natural dangers by quickly scanning incoming stimuli that are novel and/or potentially threatening. Interestingly, children with anxiety disorders who have higher levels of pretreatment amygdala activation in response to emotional information show a better response to both cognitive-behavioral therapy and drug treatment
What are the 6 symptoms of GAD? How many need to be present for how long to be diagnosed?
The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required for children. (1) Restlessness or feeling keyed up or on edge. (2) Being easily fatigued. (3) Difficulty concentrating or mind going blank. (4) Irritability. (5) Muscle tension. (6) Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep).
What is graded exposure?
The child and therapist make a list of feared situations, from least to most anxiety-producing, and the child is asked to rate the distress caused by each situation on a scale from 1 to 10; this is called a Subjective Units of Distress Scale (SUDS) or fear thermometer. The child is then exposed to each situation, beginning with the least distressing and moving up the hierarchy as the level of anxiety permits. 75% success rate
What is a depressive rumination style?
To focus narrowly and passively on negative events for long periods - Depressed children often devalue their own performance by not acknowledging their accomplishments. They dismiss praise when it is given and frequently make inaccurate interpretations of their experiences iew themselves as ineffective in most areas of their lives, and they make self-directed disparaging comments when faced with further failure or rejection (e.g., "It must be my fault.").
What are the 2 other criteria for diagnosing a panic disorder?
The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders). (D) The disturbance is not better accounted for by another mental disorder.
What is the other major criteria needed for a diagnosis of Seperation Anxiety Disorder?
The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder.
What about P-DD makes it a serious problem?
The early onset and extended duration of P-DD make it a serious problem. Children who develop the disorder at age 9 then recover 4 years later will have spent more than 30% of their entire lives and over 50% of their school-age years being depressed. Since depression is associated with many other academic, cognitive, family, and social problems, these longlasting episodes of P-DD can have extremely harmful effects on development
What is the critical period of maternal depression?
The first year of a child's life seems to be a particularly sensitive period for the effects of maternal depression on the child's later behavior and other adverse outcomes
What is the fundamental sttribution bias? the self-serving-bias in attribution?
The fundamental error of attribution. A tendency to over-value personal explanations for behavior while ignoring situational explanations. The fundamental attribution error is most visible when people explain the behavior of others. There tend to be cultural differences in attribution style and bias Self-serving-bias in attribution attributing dispositional and internal factors for success attributing external and uncontrollable factors for failure.
What is the Cognitive-Behavioral Therapy (CBT) treatment of depression?
The most common form of psychosocial intervention. Combines elements of behavioral and cognitive therapies in an integrated approach. Attribution retraining may also be used to challenge the youngster's pessimistic beliefs.
Does SOC increase or decrease with age?
The prevalence of SOC appears to increase with age, with considerable persistence and fluctuations in symptom severity over time
What 3 important points about the diagnosis of major depressive disorder in children and teens are discussed in the text?
The same DSM-5 criteria for diagnosing adults can be used to diagnose school-age children and adolescents. ▲ Because children's disruptive behaviors attract more attention, or are more easily observed as compared with internal, subjective suffering, depression in children can be easily overlooked. ▲ Some features of depression are likely more common in children and adolescents than in adults— notably, irritable mood. In light of this, DSM-5 specifies that irritable mood can substitute for depressed mood in diagnosing depression in children. However, most children with depression display either depressed mood alone (58%) or depressed and irritable mood (36%)—irritable mood alone is rare (6%)
Why might we see a sharp increase in teen depression?
The sharp increase in adolescence may result from biological maturation at puberty interacting with developmental changes
What is the filtering thinking trap?
This happens when we only pay attention to the bad things that happen, but ignore all the good things. This prevents us from looking at all aspects of a situation and drawing a more balanced conclusion.
What is the over estimating danger thinking trap?
This is when we believe that something that is unlikely to happen is actually right around the corner. It's not hard to see how this type of thinking can maintain your anxiety. For example, how can you not feel scared if you think that you could have a heart attack at any time?
What is the catostraphizing thinking trap?
This is when we imagine that the worst possible thing is about to happen, and predict that we wont be able to cope with the outcome. But, the imagined worst-case scenario usually never happens and even if it did, we are most likely able to cope with it.
What is the blacka nd white thinking trap?
This is when we only look at situations in terms of extremes: things are either good or bad, a success or a failure. But, in reality, most events call for a more 'moderate' explanation. For example, missing one class assignment does not mean you have failed the entire course ~ you just need to get caught up in class and/or complete the next assignment.
What is the fortune telling thinking trap?
This is when we predict that things will turn out badly. But, in reality, we cannot predict the future because we don't have a magic ball!
What is the over generalization thinking trap?
This is when we use words like 'always' or 'never' to describe situations or events. This type of thinking is not helpful because it does not take all situations into account. For example, sometimes we make mistakes, but we don't always make mistakes.
What is the should statements trap?
This is when you tell yourself how you "should", "must", or "ought" to feel and behave. However, this is NOT how you actually feel or behave. The result is that you are constantly anxious and disappointed with yourself and/or with others around you.
What is the mind reading thinking trap?
This trap happens when we believe that we know what others are thinking and we assume that they are thinking the worst of us. The problem is that no one can read minds, so we don't really know what others are thinking!
What are some of the cognitive symptoms of anxiety?
Thoughts of being scared or hurt Thoughts or images of monsters or wild animals Self-deprecatory or self-critical thoughts Thoughts of incompetence or inadequacy Difficulty concentrating Blanking out or forgetfulness Thoughts of appearing foolish Thoughts of bodily injury Images of harm to loved ones Thoughts of going crazy Thoughts of contamination For children with anxiety disorders, it is difficult to focus on everyday tasks because their attention is consumed by a constant search for threat or danger. When these children can't find proof of danger, they may turn their search inward or distort situation or both
What are some acute warning signs of suicide? (7)
Threatening to hurt or kill him or herself, or talking of wanting to hurt or kill him/herself; and or, Looking for ways to kill him/herself by seeking access to firearms, available pills, or other means; and/or, Talking or writing about death, dying or suicide, when these actions are out of the ordinary.
What is the medication treatment of depression?
Treats mood disturbances and other symptoms of depression using antidepressants, especially selective serotonin reuptake inhibitors (SSRIs).
What is the problem with using tricylic anidepressents to treat depression in youth?
Tricyclic antidepressants consistently fail to demonstrate any advantage over placebo in treating depression in youth They have potentially serious cardiovascular side effects
What proportion of youth with SOC have another anxiety disorder? What is the most common
Two-thirds of children and adolescents with SOC have another anxiety disorder—most commonly, generalized anxiety disorder
How have recommended treatments of youth with BP changed recently?
Until very recently, recommended treatments were based on findings with adults; however, as we saw with tricyclic antidepressants, such an extrapolation may not be warranted mood-stabilizing medications need to be used with caution and conservatively with young people with BP, particularly in those who do not fit the classic presentation of symptoms seen in adults with bipolar I disorder; these youngsters may constitute as many as 75% of cases of BP
What is the fear of bees called? What about great mole rat?
apiphobia, a fear of bees zemmiphobia, a fear of the great mole rat
What is a neurotic paradox?
When children experience fears beyond a certain age, in situations that pose no real threat or danger, and to an extent that seriously interferes with daily activities, anxiety is a serious problem. Even if the child knows there is little to be afraid of, he or she is still terrified and does everything possible to escape or avoid the situation pattern of self-defeating behavior
How does anxiety relate to cognitive errors and biases?
When faced with a clear threat, both nonanxious and anxious children use rules to confirm information about danger and minimize information about safety highly anxious children often do this in the face of less obvious threats, suggesting that their perceptions of threats activate danger-confirming thoughts difference is that children with conduct problems select aggressive solutions in response to a perceived threat, whereas anxious children choose avoidant solutions that emphasize personal safety
How are some of the more notable symptoms of mania expressed in youngsters with BP?
When in a manic state, youngsters show great conviction about the correctness or importance of their ideas. Adolescents with BP may show grand delusions—illogical and strong beliefs that lead to poor judgment and impulsive behavior may intentionally fail subjects, acting on their illogical belief that children can choose what to pass or fail because they believe they are not being taught correctly. They may steal expensive items and be unresponsive to efforts by police or parents to explain that their actions are wrong and illegal. Although know that stealing is illegal for others, they believe they are above the law may believe that they will achieve great fame, for example, as a brain surgeon, even though they are failing all of their classes at school. A child with mania might spend several hours at bedtime rearranging clothes in a dresser or closet, or an adolescent may wait until his or her parents are asleep and then sneak out of the house to go a party. ncreased verbal production with puns, word plays, and incessant speech are common Accepting dares is common - may appear as a pattern of reckless driving that results in multiple tickets for speeding or driving under the influence. In preadolescents, it may be expressed as grandiose delusions of being able to jump out the window because they believe they can fly. extreme cases, they may experience violent agitation with delusional thinking as well as visual and auditory hallucinations.
Why do the physical symptoms of the fight/flight response occur if an adolescent is not initially frightened?
Why do the physical symptoms of the fight/flight response occur if an adolescent is not initially frightened? Another possibility is that the youngster may breathe a little too fast (subtle hyperventilation), which also can produce symptoms. Because the over-breathing is very slight, the child gets used to it and does not realize that he or she is hyperventilating. A third possibility is that some youngsters are experiencing normal bodily changes but, because they are constantly monitoring their bodies (as adolescents are prone to do), they notice these sensations far more readily
What are the 4 specifications for OCD?
With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true. With poor insight: The individual thinks obsessive- compulsive disorder beliefs are probably true. With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true. Tic-related: The individual has a current or past history of a tic disorder.
What are the 5 major black box warning for the use of antidepressants iwth children and teens?
Youths with MDD are at an increased risk for suicidal thinking or behavior. ● When considering an antidepressant for a child or adolescent, it is important to weigh the increased risk of suicidality with the possible benefits of the medication. ● When starting young people on antidepressants, they must be very closely monitored for worsening of symptoms, suicidality, or unusual changes in behavior. ● Family members must closely observe the youngster for increases in symptoms or worsening of functioning, and immediately communicate any such observations to their provider. ● A statement needs to be included regarding whether the medication is approved for use with children and adolescents.
What is Primary and Secondary Control Enhancement Training (PASCET)? What are the two types of skills it focuses on?
a 15-session, individualized CBT-based program for youngsters 8 to 15 years of age who have depression. In treatment sessions and in take-home assignments, youngsters learn and practice two types of coping skills: ▲ Primary control skills (ACT skills) for changing objective events in their lives (e.g., changing the activities they engage in, learning to relax) to conform with their wishes. ▲ Secondary control skills (THINK skills) for altering the subjective impact of stressful life events (e.g., altering their negative thoughts and feelings). focus of the PASCET program is to help the child change conditions that are changeable and to change the subjective impact of those that are not. Parents are also involved in the program and are encouraged to support their children in using these coping skills
What are the most common and most heritable specific phobias?
a fear of events in the natural environment (e.g., heights, thunder) and a fear of animals, particularly dogs, snakes, insects, and mice
How much more likely is someone with MDD to attempt suicde?
a fivefold increased risk of a first suicide attempt as compared with controls without MDD, and nearly 8% of them committed suicide within 15 years of their first episode of MDD
What is needed for a diagnosis of BP II Disorder?
a hypomanic episode in combination with one or more major depressive episodes;
What types of stressful events are assocaited with depression?
a move to a new neighborhood, a change of schools, a serious accident or family illness, an extreme lack of family resources, a violent family environment, or parental conflict or divorce nonsevere stressful events, or "daily hassles," such as a poor grade on a test, an argument with a parent, criticism from a teacher, a fight with a boyfriend, or a broken date, may also result in depression. Relative to nondepressed youngsters, those who become depressed experience significantly more severe and nonsevere stressful life events in the year preceding their depression—especially events related to romantic relationships, education, relationships with friends or parents, work, and health
How have BP diagnoses changed over the last few decades? What does this suggest?
a stable rate of BP in young people over the past two decades, which is in contrast to the large increase in BP diagnoses in clinical samples over this period suggests a growing awareness and recognition of BP symptoms rather than an actual increase in rates,
What is bipolar disorder (BP)?
a striking period of unusually and persistently elevated, expansive, or irritable mood, accompanied by increased goal-directed activity or energy, and alternating with or accompanied by one or more major depressive episodes. The two mood states associated with the manic phase of BP are elation and a profound sense of well-being (euphoria). However, these feelings can quickly change to anger and hostility if something interferes with the youngster's behavior. Since many youngsters with BP have simultaneous feelings of depression, they are easily reduced to tears
What is a panic attack?
a sudden and overwhelming period of intense fear or discomfort that is accompanied by four or more physical and cognitive symptoms characteristic of the fight/flight response Usually, a panic attack is short, with symptoms reaching maximal intensity in 10 minutes or less and then diminishing slowly over the next 30 minutes or the next few hours. Panic attacks are accompanied by an overwhelming sense of imminent danger or impending doom, and by an urge to escape. Although they are brief, they can occur several times a week or month
What is the average age of onset for selective mutism?
about 3 to 4 years; however, there is often a considerable lag between onset and referral, possibly because the child's mutism may not occur at home. With school entry and the associated increase in social interaction and tasks (e.g., reading aloud), the child is more likely to be identified and referred. The persistence of selective mutism is variable, although many children seem to "outgrow" the disorder. However, research in this area is limited, and the long-term course of the disorder is not known
What is the prevelence rate of depression in mothers of children with depression?
about 50% to 75% - A family history of depression is also greater in first-degree relatives of children with depression than in children without depression
What proportion of those with MDD are likley to develop a bipolar disorder? What is this called?
about one-third of adolescents with MDD will develop a bipolar disorder within 5 years after the onset of their depression, known as a bipolar switch
How is activation of the HPA axis related to anxiety?
activation of the HPA axis is closely related to the regulation of stress and fear and involves the release of cortisol needed to meet a challenging situation. Pathological anxiety has been related to elevations of cortisol secretion, reflected in an exaggeration of normal HPA reactions or a failure of the HPA axis response to habituate to repeated exposure to the same stressor Prolonged exposure to elevated levels of cortisol as a result of early stress or trauma may have neurotoxic effects on the developing brain—for example, reduced cerebral volume or changes in the volume of the hippocampus
What is child's game?
active listening with little kids - pay with the kid - don't give single command don't ask questions (not trying to teach) parallel play - you sit beside and do the same thing - every so often you comment (eg oh I see you're putting the blocks in the box)
What is another name for a mood disorder (chap 10)
affective disorder
Do boys or girls experience more SOC? Why?
affects nearly twice as many girls as boys Girls may experience greater social anxiety because they are more concerned with social competence than are boys and attach greater importance to interpersonal relationships and evaluation by peers
Why is school based screening for depression important?
although 90% of parents report that they are confident in their ability to tell if their child is thinking about suicide, the parents of only about one-third of teens with mental health problems know that their child has these problems. School-based screening for suicide has had moderate success in identifying students who are at high risk for suicide and other mental health problems, but concerns have been raised regarding the number of youngsters who are falsely identified as being at risk
How does the amygdala impact rumination? How does this affect those with depression\'?
amygdala may overstimulate brain structures involved in forming certain types of memories, perhaps accounting for the tendency of depressed youngsters to ruminate on past negative life events. Overactivity of the amygdala may also affect the recognition and consolidation of social stimuli (e.g., faces, tone of voice) from a very early age so that ordinary interpersonal events are seen or recalled as aversive or emotionally arousing
How does the size of certian area relate to later depression? What parts are most often disucssed?
amygdala, hippocampus, and thalamus Smaller volumes of several of the aforementioned brain structures in infants as young 6 weeks of age have been associated with higher levels of internalizing behaviors at 18 and 36 months of age. These findings suggest a possible biological vulnerability for the development of internalizing problems that may be present early in life. Studies have also identified cortical thinning in the right hemispheres of children and adults with or at risk for depression based on family history Cortical thinning in the right hemisphere might produce disturbances in arousal, attention, and memory for social stimuli that predispose the individual to developing a depressive disorder.
How do brain structures relate to anxieties? What is a behavioural inhibition?
amygdala, which has a primary function of reacting to unfamiliar or unexpected events Children with a high threshold for novelty are presumed to be at low risk for developing anxiety disorders. Other children (about 15% to 20%) are born with a low threshold for becoming overexcited and to withdrawing in response to novel stimulation as infants, a tendency to be fearful and anxious as toddlers, and a tendency to be unusually shy or withdrawn in novel or unfamiliar situations as young children. This type of temperament is called behavioral inhibition (BI), an enduring trait for some and a predisposing factor for the development of later anxiety disorders, particularly SOC
What is nocturnal panic?
an abrupt waking in a state of extreme anxiety that is similar to a daytime panic attack. Nocturnal panic attacks usually occur in adolescents who suffer from PD. They prevent a return to sleep and are vividly recalled the next day
What is a 'flight of ideas'?
an illogical jump from one idea to another.
What can happen when someone with SOC is forced into a social situation?
anxiety associated with SOC can be so severe that it produces stammering, sweating, upset stomach, rapid heartbeat, or a full-scale panic attack.
What are the most common co-occuring disorders for youth with a specific phobia?
anxiety disorder and depressive disorders
What are some of the co-occuring disorders with BP? (7) What is a possible reason for this?
anxiety disorders, ADHD, ODD, CD, substance-use problems, and suicidal ideation and suicide attempts These disorders share many overlapping symptoms with BP, possibly related to shared underlying processes for what are currently assumed to be distinct disorders
How was anxiety in children initially regarded?
anxiety in children was thought to be a mild and transitory disturbance that would fade over time with normal life experiences
What is the fight/flight response?
anxiety involves an immediate reaction to perceived danger or threat anxiety involves an immediate reaction to perceived danger or threat
Is anxiety always bad?
anxiety is both expected and normal at certain ages and in certain situations. One-year-old infants become distressed when separated from their mothers, and almost all young children have short-lived specific fears—of the dark, for example. The child's world can be a strange and menacing place, full of unknown dangers—some real, others imagined. Although no one likes to feel anxious, not feeling anxious when the situation calls for it is far worse. Anxiety often hits us when we do something important, and in moderate doses it helps us think and act more effectively
What are the 2 accompanying problems with depression discussed in the text?
anxiety or oppositional/conduct disorders
What are the 3 groups of selective mutism?
anxious—mildly oppositional; (2) anxious—communication delayed; and (3) exclusively anxious (
When were symptoms of BP first recognized?
as early as 150 c.e., when the physician Aretaeus of Cappadocia described manic behavior in young men in puberty
What percent of those with bp also have ODD or cd? Which symptoms do the two have in common?
as many as 80% Symptoms of grandiosity, mania, and poor judgment in BP may be confused with symptoms of conduct problems. running away, driving under the influence, substance abuse, sexual promiscuity, and stealing. Similarly, the flight of ideas and/or pressured speech associated with mania may be mistaken for a language disorder
What are the 8 symptoms used to diagnose Seperation Anxiety Disorder? How many need o be seen for how long?
at least three of the following: (1) Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures. (2) Persistent or excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death. (3) Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure. (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 to go to sleep without being near a major attachment figure. (7) Repeated nightmares involving the theme of separation. (8) Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.
What is the average duration of syptoms of a social anxiety?
average duration of symptoms of social anxiety is about 20 to 25 years—thus, it is not a short-lived condition of adolescence and young adulthood. In the absence of effective treatment, the likelihood of a complete and long-lasting remission for SOC is the lowest for all anxiety disorders
What is the Interpersonal Psychotherapy for Adolescent Depression (IPT-A)?
based on the idea that adolescent depression affects relationships, which in turn affect mood. Thus, treatment focuses on the adolescent's depressive symptoms and the social context in which these symptoms occur emphasis in IPT-A is on increasing adolescents' independence and negotiating their interdependence on others by addressing relevant developmental issues such as romantic relationships, separation from parents, and peer relationships. The adolescent takes an active role in identifying a specific problem area (e.g., loss and grief, interpersonal disputes, role transitions, interpersonal deficits), discussing communication and problem-solving techniques for that area, practicing these skills in session, and applying them outside sessions in the context of significant relationships. The treatment is structured around addressing the identified problem areas, and both the therapist and adolescent are expected to play an active role once-weekly, 12-session outpatient program.
Why shouldn't Benzodiazepine be used over a long period of time to get rid of anxiety?
because gets rid of anxiety altogether, don't learn how to adapt
Why may SOC be overlooked?
because shyness is common and because these children are not likely to call attention to their problem even when they are severely distressed
What is bad thought ocd? What are symetry obsession or counting obsessions?
because think of something something bad will happen - because only turn light on one time - later parents house will catch on fire - way to make sure doesn't turn light off twice Symetry obessions - have stand same amount time each leg for eg Counting obsession - have to do certain number times prevent bad thing
What is one-session treatment?
begins with presession meeting(s) with the child and family to build rapport and provide information about anxiety and therapy. This is followed by a 2.5- to 3-hour long, single-session of massed exposure therapy that, in addition to exposure, uses a variety of CBT techniques, such as reinforcement, participant modeling (see below), psychoeducation, skills training, and cognitive challenges
What are the 5 treatments for depression discussed in the text?
behaviour therapy cognitive therapy cognitive-behavioural therapy (CBT) Interpersonal psychotherapy for adolescent depression (ITP-A) Medication
What are the 4 types of BP?
bipolar I disorder; bipolar II disorder; cyclothymic disorder; and other specified bipolar disorder
How do SSRI's work?
blocking the reuptake of serotonin, thereby increasing its availability in the synapse and stimulating the postsynaptic neuron
What are the physical characteristics of people with who a re likleiy to have more behavioural inhibition?
blonde haired blued eyed people
What is the intention of compulsions?
both reduce anxiety and stop excessive thought
What do we tend to see in youth with multiple obsessions and compulsions?
children with OCD have multiple obsessions and compulsions, and certain compulsions are commonly associated with specific obsessions Obsessions with symmetry, exactness, or order are often associated with compulsions for arranging and ordering, such as repeatedly packing and unpacking a suitcase or rearranging drawers
How does SOC become a self-fulfilling prophecy?
children with SOC anticipate their awkwardness and poor performance, which triggers further anxiety as they approach the feared situation, and further increases their nervousness and physical symptoms. As a result, they avoid social activities such as calling a classmate for missed homework, asking the teacher to explain something, answering the telephone, going to parties, and dating
How do children with depression and children with anxiety differ on the affectivty?
children with anxiety do not differ from children with depression in their negative affect, which suggests that a general underlying dimension of negative affectivity is common between anxiety and depression may be the lower positive affectivity in those who are depressed
What is pressured speech and how does it relate to BP?
children with mania show pressured speech—they talk too much and too fast, change topics too quickly, and cannot be interrupted. They also have racing thoughts that they may describe in concrete terms—for example, by saying they can't do their schoolwork because their thoughts keep interrupting.
What is the prognosis of BP?
chronic and resistant to treatment, with a poor long-term prognosis similar to that in adults adolescents with BP, nearly 50% had a relapsing course or never achieved complete remission , adolescents with BP may have a more prolonged early course and a poorer response to treatment. However, long-term prognosis appears to be similar to that for adults, with most patients continuing to experience significant symptoms and functional impairment
Where do we find higher rates of BP? (3)
clinic versus community samples; older versus younger participants; and samples that define BP more broadly and include participants with cyclothymic disorder and other specified BP
What is the most effective procedure for treating anxiety disorders in young people? Describe this method
cognitive-behavioral therapy (cbt) In addition to using behavior therapy procedures, CBT teaches children to understand how thinking contributes to anxiety and how to modify their maladaptive thoughts to decrease their symptoms
Is SAD more common in boys or hirls?
common in both boys and girls, although it is more prevalent in girls
What is lithium? What are some of the side effects? When can't it be given?
common salt that is widely present in the natural environment—for example, in drinking water—usually in amounts too small to have any effects. the side effects of therapeutic doses of lithium can be serious, especially when used in combination with other medications; side effects may include toxicity (poisoning), renal and thyroid problems, and substantial weight gain cannot be given to children in chaotic families or to children who are unable to keep the multiple appointments needed for monitoring potentially dangerous side effects
What is the ACTION Program? What does it stand for?
comprehensive CBT approach for children with depression. The primary components of this treatment are appropriate for children and adolescents and for boys as well as girls. However, the current format is designed to be gender-sensitive, with treatment activities, skills emphasized, and a focus on interpersonal relationships specific to girls in the 9- to 13-year age range uses a holistic approach that involves both child and parents. A - Always find something to do to feel better. C - Catch the positive. T 5 Think about it as a problem to be solved. I - Inspect the situation. O - Open yourself to the positive. N - Never get stuck in the negative muck.
why should kids not use trycillic medications?
consistently failed to demonstrate any advantage over placebo in treating depression in young people, and may have some potentially serious cardiovascular side effects
What does a typical treatment plan for BP look like?
currently no cure for BP, in most cases treatment can stabilize mood and allow for management and control of symptoms. Treatment of BP generally requires a multimodal plan that includes close monitoring of symptoms, educating the patient and the family about the illness, matching treatments to individuals, administering medications such as lithium or atypical antipsychotics to stabilize mood, and performing psychotherapeutic interventions to address the youngster's symptoms and related psychosocial impairment
What is Dysthymic disorder?
depressed mood is generally less severe but with longer lasting symptoms (a year or more) and significant impairment in functioning
What is the most common predisturbance in youth with pd?
depressive disorder
What are the two major types of mood disorders in DSM-5?
depressive disorders and bipolar disorders
What is needed for a diagnosis of cyclothymic disorder ? What is it?
describes children or adolescents who display numerous and persistent hypomanic and depressive symptoms for a year or more that cause considerable distress and impairment in functioning, but do not meet criteria for a manic episode or for a major depressive disorder
What is needed for a diagnosis of ther specified bipolar disorder ? What is it?
describes individuals who display characteristic symptoms of BP that cause significant functional impairment but do not meet criteria for any of the other types of bipolar disorder
How is diagnosing youth with BP different from adults?
developmental limitations and the social environment place constraints on children's reckless behaviors, which typically involve school failure, fighting, dangerous play, and inappropriate sexual conduct. Thus, classic manic symptoms of grandiosity, psychomotor agitation, and reckless behavior must be differentiated from manic symptoms of common childhood disorders, such as ADHD and conduct problems, and from typical childhood behaviors, such as bragging, imaginary play, overactivity, and youthful blunders
Which kind of therapy is best?
different treatments don't very much - any is better than non
is school refusal more common in girls or boys? At what age is it most common?
equally common in boys and girls, and it occurs most often between the ages of 5 and 11 years. first occur during preschool, kindergarten, or first grade and peak during the second grade - can occur at any time and may have a sudden onset at a later age
Why does having a depressed mother increase the liklihood that a child is depressed?
difficulties regulating their emotions and experience decreased social acceptance as young as age 5 children are ill equipped to cope effectively with stressful events, which subsequently places them at risk for higher levels of depression, lower functioning across multiple domains, and lower perceived competence by adolescence or earlier, maternal depression is associated with greater mutual engagement in negative affect during parent-child interactions, rather than solely reflecting the mothers' own negativity
How do families tend to treat depressed children?
display more critical and punitive behavior toward their depressed child than toward other children in the family. As compared with families of youngsters without depression, these families display more anger and conflict, greater use of control, poorer communication, more overinvolvement, and less warmth and support high levels of stress, disorganization, marital discord, and a lack of social support
What symptoms are seen in youth with BP?
display significant impairment in functioning, including previous hospitalization, MDD, treatment with medications, and co-occurring disruptive behavior and anxiety disorders history of psychotic symptoms and suicidal ideation and suicide attempts are also common show severe and cyclical mood changes and outbursts. During a manic episode may display intense symptoms, such as irritability and rage. Or they may show silly, giddy, overexcited, overtalkative behavior coupled with expansive, grandiose beliefs (e.g., a teen who feels she has a special connection to God) (will actually believe is isindestructible and all-powerful) might believe can walk on water, control traffic, or jump off buildings without hurting himself) Restlessness, agitation, and sleeplessness are also typical of youngsters with BP. Sexual disinhibition may also occur - uncharacteristically preoccupied with sexual themes, sexually touching others, or "talking dirty" unrealistic elevations in self-esteem (believing they are "the chosen one") and vast surges of energy; they may go with little or no sleep for days without feeling tired. concentrate for hours on one activity that interests them, such as drawing or becoming engrossed in a mentally demanding fantasy game. At the same time, however, they may be highly distractible, constantly jumping from one thing to another (
What is the upward spiral of teen coping with depression?
do something successful - feel good - have fun with friends - feel even better - do well in school - feel great
What has research found about specific regions of the brain with regardss to depression?
e implicated regions on several chromosomes. However, findings generally suggest that no specific region makes a large contribution to the risk of MDD and that multiple regions are involved Studies of specific genes have focused primarily on those involved in the synthesis, release, and reuptake of the neurotransmitter serotonin and to a lesser extent on other genes, such as brainderived neurotrophic factor (BDNF), that have been implicated in brain plasticity and response to stress
What is the average age of onset for gad?
early adolescence
How does BP effect boys and girls?
effects boys and girls equally. However, symptoms may be expressed differently, with boys showing more manic moods and girls more depressed moods boys seem to be affected more often than girls, especially when the age of onset is younger than 13 years.
What is the most common compulsions?
excessive washing and bathing (occurring in about 85% of cases), repeating, checking, touching, counting, hoarding, and ordering or arranging
What is flooding and response prevention?
exposure is carried out in prolonged and repeated doses (massed exposure). Throughout the process, the child remains in the anxiety-provoking situation and provides anxiety ratings until the levels diminish. typically used in combination with response prevention, which prevents the child from engaging in escape or avoidance behaviors
What do internalizing and externalizing problems predict with regards to anxiety?
externalizing problems predict later anxiety disorders, whereas internalizing symptoms are generally better predictors of mood disorders
What is a mood disorder? How prevelent are they?
extreme persistent or poorly regulated emotional states (Eg excessive unhappiness, ongoing irritability or anger, swings in mood from deep sadness to high elation) - one of most common, chronic and disabling illnesses in young people
are panic attacks common in young children? Why?
extremely rare in young children, they are common in adolescents significance of pubertal development and anxiety disorders in females has received general support - Given that spontaneous panic attacks are rare before puberty and are related to pubertal stage, and that adolescence is the peak time for the onset of the disorder, the physical changes that take place around puberty seem critical to the occurrence of panic.
What is the theory of attachment of anxiety?
fearfulness in children is biologically rooted in the emotional attachment needed for survival. Infants must be close to their caregivers if their physical and emotional needs are to be met. Attachment behaviors, such as crying, fear of strangers, and distress, represent active efforts by the infant to maintain or restore proximity to the caregiver. Separation gradually becomes more tolerable as the child gets older. However, children who are separated from their mothers too early, who are treated harshly, or who fail to have their needs met consistently show atypical reactions to separation and reunion. Early insecure attachments become internalized and determine how children see the world and other people. Children who view the environment as undependable, unavailable, hostile, or threatening may later develop anxiety and avoidance behavior.
What do behavioural and learning theories of anxiety focus on? What is the two-factor theory?
fears and anxieties were learned through classical conditioning Operant conditioning has been cited in explaining why fears persist once they are established. The principle is that behavior will continue if it is reinforced or rewarded. Once something has become frightening, there is the automatic reward of instant relief whenever the child avoids the feared object or situation. Thus, through negative reinforcement, avoidance of a feared stimulus becomes a learned response, which serves to maintain the child's fear even when not exposed to it. The combination of classical and operant conditioning in the learning and maintenance of fears is called the two-factor theory
What is a hypomanic episode?
features that resemble a manic episode in quality but are less intense—the mood disturbance and increased activity or energy are less severe, of shorter duration, and produce less impairment in functioning than a manic episode
What is the downward spiral of teen coping with depression?
feel unhappy - spend more time alone - feel depressed - become less active - feel more depressed - do even less
are girls or boys more likley to experience panic attacks?
females are about twice as likely as adolescent males to experience panic attacks
What is systematic desensitization?
first train physical response - how to relax, breathing etc Once have that down then show picture of snake and cue to do relaxation - keep doing this until no more response at all then show skin and same Works but very long process Turns out exposure alone same process - don't need to teach how to relax body Therefore don't go through steps SD anymore unless very extreme - eg show picture and run out of building
What area of the brain do studies on depression tend to focus on? What have they found?
focused on neural systems that regulate emotional functions such as neuroendocrine stress responses, autonomic activity, and reward sensitivity. Brain scan studies have identified multiple abnormalities in the structure and function of the amygdala, cingulate and prefrontal cortex, and related limbic and striatal brain areas amygdala, hippocampus, and thalamus have been found to have smaller volumes in adolescents and adults with depressive disorders. Interestingly, maternal depression during pregnancy is related to the microstructure of the right amygdala of newborn infants
What neurotransmitter system has been implicated in anxiety disorders most often?
g-aminobutyric acid-ergic (GABA-ergic) system - Neuropeptides are generally viewed as anticipatory stress modulators whose abnormal regulation may play a role in anxiety disorders
What are some risk factors for adolescent SOC?
gender and early BI, exposure to early maternal stress Such an outcome may depend on whether the inhibited child grows up in an environment that fosters this tendency
Describe the developmental framework of depression in young people
genetic risk influences neurobiological processes and is reflected in an early temperament characterized by oversensitivity to negative stimuli, high negative emotionality, and a disposition to feeling negative affect. These early dispositions increase exposure to and are shaped by negative experiences within the family and continue to exert influence throughout development. Core beliefs about self and others develop as a result of experiences within the family. Parenting that is insensitive, disengaged, or rejecting may lead to an insecure attachment and a view of the self as incompetent, other people as threatening or unresponsive, and relationships as negative and unpredictable. Negative family experiences may also create an inconsistent emotional and social environment, which makes it difficult for the child to effectively regulate emotions and interpersonal behavior and to cope with stress Cognitive, emotional, and interpersonal problems may lead directly to depression, or they may elicit conflict, rejection by others, and social isolation, which will eventually lead to depression. In other instances negative beliefs, poor social relationships, and difficulty in regulating emotions may create a vulnerability to develop depression when confronted with life stresses. PG 359 Diagram
What has science shown is the biggest contributor to happiness?
gratitude?
What is Hoarding Disorder?
haracterized by persistent difficulty discarding or parting with possessions, regardless of their actual value.
How have learning social cues in childhood been implicated with anxiety?
has been proposed that abnormalities in learning safety cues in childhood may establish threat-related appraisal biases early in development, which may then lead to chronic anxiety disorders in adulthood healthy teens have greater difficulty distinguishing between threat and safety cues than adults, relying more on areas of the brain involved in basic fear responses (hippocampus, right amygdala) than on areas involved in more reasoned judgment about what is safe or not (prefrontal cortex) - may be one reason why teens (and youths with anxiety disorders) generally report more pervasive worries and are more vulnerable to stress-related problems
At what point does a fear of something becomes a phobia?
has to causse impairment - eg wont go into the backyard bc of fear of bees
Are computer based CBT programs effective in treating anxiety?
have also been shown to be effective in treating anxiety disorders and OCD in children and adolescents dded benefit of using less therapist time and/or providing greater access for families who have difficulty accessing clinic-based treatment, making it a viable and cost-effective option for many youngsters with anxiety disorders
What is the main technique of berhaviour therapy for phobias and anxieties?
having children face what frightens them, while providing ways of coping other than escape and avoidance
How has the anterior cingulate cortex found to relate to depression?
healthy adolescents who respond to peer rejection with greater activation of the anterior cingulate cortex are more likely to show an increase in depressive symptoms over the following year. These findings suggest that activity in brain regions involved in affective processing of socioemotional stimuli may provide a possible neurobiological marker for predicting healthy youngsters' future risk for depression.
What is the best predictor of a child's risk for MDD?
high family incidence for this disorder Children with a parent who suffered from depression as a child are 14 times more likely than controls to become depressed themselves before the age of 13
What comorbid dissorder is most common with GAD? What are soem others?
high rate of other anxiety disorders. For younger children, co- occurring SAD and conduct problems are most common; older children with GAD tend to have specific phobias, SOC, panic disorder, and MDD, as well as impaired social adjustment, low self-esteem, and an increased risk for suicide
What does evolutionary theory say about fears?
human infants are biologically predisposed as a result of natural selection to learn certain fears sources of most children's phobias can be traced to the natural dangers encountered during human evolution—snakes, the dark, predators, heights, blood, loud noises, and unfamiliar places. For example, when listening to evolutionary fear-relevant sounds (e.g., snake hissing), infants as young as 9 months of age display heart rate slowing, an increased eye-blink startle response, and more visual orienting, as compared to when they listen to modern fear-relevant sounds (e.g., siren wailing) or pleasant sounds fears are adaptive in an evolutionary sense because they alert the individual to possible sources of danger, thereby increasing the likelihood of survival
What is diathesis-stress model of depression ?
impact of stress may be moderated by individual risk factors, such as genetic risk occurrence of depression depends on the interaction between the youngster's personal vulnerability (diathesis) and life stress
What are the 8 effects of sleep distrubances on school functioning according to lecture?
impaired cognitive functioing, poor mental health, imaired attention and concentration, impaired emotion regulation, reduced particpation, poor daytime behaviour and functioning, increased impulsivity, poor academic success,
What is the average age of first panic attack?
in adolescents with PD is 15 to 19 years, and 95% of adolescents with the disorder are postpubertal
What is the role of the parent in the ACTION Program?
ince negative parent- child interactions may result in negative thinking, changing maladaptive patterns within the family is an important feature of the ACTION program. Several methods are used to change parental and family cognitions and behavior, including teaching parents effective forms of discipline, ways to manage anger, and ways to change negative thinking. Interventions with the entire family teach negotiation and conflict-resolution skills, recreational planning, and effective problem solving and family communication
Is the incidence of BP prior to puberty common?
incidence of BP prior to puberty is extremely rare, but it increases during adolescence and is nearly as high as it is for adults
What does the Guidelines for media reporting of suicide say should be included (5) and avoided (11)?
include - alternatives (treatment) - resourses in community - exampes of positive outcomes (eg call hotline) - warning signs of suicidal behavioura - how to approach sucidal person avoid - details of method word suiide in headline - photos - admiration of deseased - idea suicide unexplanable - repetitive coverage - front page - exciting reporting - romanticized reasons for suicide - simplistic reasons for suicide - approval of suicide
What types of dysfunctions do we see in kids whose parents are depressed?
increased rates of depression, particularly before puberty, but also higher rates of phobias, panic disorder, and alcohol dependence parents received more outpatient treatment over 10 years and had poorer overall functioning in work, family, and marital relationships. In terms of health-care use, children of depressed parents have a higher rate of medically attended physical injuries in the home, emergency and sick visits, and inpatient and specialty-service use and a lower rate of well-child care visits
What are the two newly proposed disorders in the DSM-5 about self-injurious behaviour?
individuals who have made a suicide attempt within the past 24 months, and Nonsuicidal Self Injury describes individuals who engage in intentional self-inflicted damage to the surface of the body (e.g., cutting, burning, stabbing, excessive rubbing) without suicidal intent
What are the 3 phases of the Interpersonal Psychotherapy for Adolescent Depression (IPT-A)? Describe each
initial phase (4 sessions) addresses the diagnosis of depression, educates the adolescent and family about depression, introduces the principles of IPT-A and the structure of treatment, identifies an interpersonal problem area, and makes a treatment contract. The middle phase (5 sessions) further clarifies the problem, identifies strategies for effectively targeting the problem, and implements interventions to resolve the problem focus on helping the adolescent to recognize the impact of her communication on others, the feelings generated, and how modifying the communication may impact the outcome of the interaction and the adolescent's associated feelings. Additional techniques involve problem solving in interpersonal situations, role playing both communication and problem-solving skills, and the use of homework to practice these skills between sessions The termination phase (3 sessions) reviews progress in the identified problem area, links changes in interpersonal functioning and relationships to improved mood and decreased depressive symptoms, and identifies strategies that have been most helpful. It also addresses the importance of continuing to use the learned strategies following treatment, highlights areas that still need improvement, and considers what to do if symptoms of depression return.
What is a manic episode?
is the hallmark feature of BP, involves a discrete period of a week or more during which the youngster displays an ongoing, pervasive, and unusually elevated or irritable mood and persistently increased goal-directed activity or energy. does not meet criteria for a depressive episode during the period of mood disturbance and increased energy and activity; the mood disturbance is not due to substance use or abuse or to a medical condition; and the disturbance causes significant impairment in usual activities or requires hospitalization in order to prevent the child or others from harm.
does family dysfunction lead to anxiety?
it is unclear whether family dysfunction relates specifically to anxiety disorders
What is the prevelence of GAD?
least common anxiety disorder reported in a large national survey of more than 10,000 teens (13 to 18 years of age) in the United States, with a lifetime prevalence rate of 2.2% more recent study found that it was the most common anxiety disorder diagnosis (37%) among children referred to an anxiety specialty clinic
what direction is the link between family dysfuntion and childhood depression?
less support and more conflict in the family were associated with more depressive symptoms in adolescents both concurrently and prospectively over a 1-year period. In contrast, more depressive symptoms did not predict a worsening of family relationships over the same time period. Thus, family problems precede and may be directly related to the development of depressive symptoms
What proportion of youth with depression recieve help? How does this change depending on ethnicity?
less than half highest for non-Hispanic white youths (40%) and lowest for Asian youths (19%). About one-third of African American and Hispanic youths receive treatment for their depression
What is the prevelence of OCD?
lifetime prevalence of OCD in children and adolescents is about 1% to 2.5%, suggesting that it occurs about as often in young people as in adults
How does parental anxiety affect the likelihood of a child having anxiety?
likely to have but children do not necessarily have the same disorders as their parents
What do kids with GAD tend to worry about?
likely to pick up on every frightening event in a movie, on the Internet, or on TV and relate it to themselves. If they see a news report on TV about a car accident, they may begin to worry about being in a car accident themselves. They always expect the worst possible outcome and underestimate their ability to cope with situations or events that are less than ideal. They do not seem to realize that the events they worry about have an extremely low likelihood of actually happening. hey also worry excessively about minor everyday occurrences, such as what to wear or what to watch on TV. This generalized worry about minor events distinguishes children with GAD from those with other anxiety disorders
What drug has been FDA approved to treat BP in youth 12 and older? younger than 12?
lithium for use in children as young as 12 years of age. currently no drugs that are FDA-approved for the treatment of BP younger medication treatment for adolescents with BP are rapidly increasing in number, although few studies have evaluated effects in children younger than age 10 years of age
What is selective mutism?
m fail to speak in specific social situations in which there is an expectation to speak (e.g., at school), even though they may speak loudly and frequently at home or in other settings
What are the main concerns about the use of SSRI's to treat youth depression? What has been the result of these concerns?
main concerns are possible serious side effects such as suicidal thoughts and self-harm and a lack of information about the long-term effects of these medications on the developing brain. use of SSRIs with young people has decreased by about 20% in more recent years
What are soem of the risk factors of evential mania?
major depressive episode (characterized by rapid onset, psychomotor retardation, disrupted sleep patterns, and psychotic features) and a family history of mood disorders, especially BP
How do hispanic children's anxiety compare to white children?
marked similarities in age at presentation, gender, primary diagnosis, proportion with school refusal, and proportion with more than one diagnosis. Hispanic children are more likely to have a primary diagnosis of SAD. Hispanic parents also rate their children as more fearful than do white parents
What tends to happen in youth that have had panic attacks?
may avoid locations where they've had a previous panic attack or situations or activities in which they fear an attack might occur.
What are some of the reasons for school refusal?
may be associated with submitting for the first time to authority and rules outside the home, being compared with unfamiliar children, and experiencing the threat of failure. Some children fear school because they are afraid of being ridiculed, teased, or bullied by other children or being criticized or disciplined by their teachers. In other cases, the child's fear may result from an excessive or irrational fear of being socially evaluated or embarrassed when having to recite in class or undress in front of unfamiliar people in a gym class. moving from class to class, taking classes involving public speaking, and participating in gym class. He refused to attend school mainly to escape being socially evaluated and, to a lesser extent, to gain attention from his parents
What symptoms tend to be seen in kids with school refusal behaviour?
may complain of a headache, upset stomach, or sore throat just before it's time to leave for school, then begin to "feel better" when permitted to stay at home, only to feel "sick" again the next morning. As the time for school draws near, the child may plead, cry, and refuse to leave the house and may even have a full-blown panic reaction. School refusal often follows a period at home during which the child has spent more time than usual with a parent school refusal may follow a stressful event such as a change of schools
Why is it important to consider the developmental history when disagnosing a youth with BP?
may say, "I feel absolutely terrific." It is difficult to recognize that a laughing, happy youngster also has a history of misery and distress. For this reason, evaluating a youth's current mood in relation to his or her developmental history is essential, particularly when there is an inconsistency between the child's elated mood and his or her history of trouble at home or school
is medication or therapy better to treat anxiety?
medicine and cbt (coping cat) best - then cbt - the ssri (eg zoloft) - then nothing
What is the most common BP diagnosis in children?
milder bipolar II disorder, cyclothymic disorder, and other specified BP rather than bipolar I disorder Children with a diagnosis of cyclothymic disorder or other specified BP are quite similar in terms of their current symptom severity and functional impairment to those with bipolar I disorder, suggesting that these disorders are on the same bipolar spectrum
What do current models of anxiety thoery focus on?
models of anxiety use a developmental psychopathology perspective that emphasizes the importance of interacting biological and environmental influences takes into account brain development and psychopathology and integrates this knowledge with research on genetic variation and environmental effects Genetic vulnerability reflects a disposition toward broad anxietyrelated traits, whereas early environmental risk may influence developing neural circuitry as well as the specific types of anxieties that emerge
What have twin studies found about depression?
moderate genetic influence on depression in children and adolescents, with heritability estimates ranging from 30% to 45% across studies for males and females
What is anxiety? What are the two features?
mood state characterized by strong negative emotion and bodily symptoms of tension in which the child apprehensively anticipates future danger or misfortune strong negative emotion and an element of fear.
What are two things children of depressed parents tend to have?
more psych problems and physical induries
What is the most common comorbid disorder with agoraphobia? What are some others?
most common comorbidities for agoraphobia are other anxiety disorders (e.g., PD, specific phobias, and SOC), major depressive disorder, post-traumatic stress disorder, and alcohol-use disorder
What is the most common comorbid disorder with PD? What are some others?
most commonly an additional anxiety disorder (particularly generalized anxiety disorder or SAD) and major depressive disorder. Other comorbid conditions include mania and hypomania, attention-deficit/ hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD)
Why don't children with phobias often get referred for treatment?
most parents do not view specific phobias as significantly harmful.
How are social anxiety disorders often expressed?
n children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking away, or failing to speak in social situations.
Which is the most common type of antideprresant used for youths? Which is the only one approved by the FDA for the use of children and teens with MDD?
ne national survey reporting that over 90% of prescriptions written for these youngsters were for SSRIs Among the most commonly used SSRIs are fluoxetine (Prozac), sertraline (Zoloft), and citalopram (Celexa). fluoxetine
according to the cognitive theory of depression how does negative attributional style relate to depression
negative attributional style results in the individual's taking personal blame for negative events in his or her life and leads to helplessness and avoidance of these events in the future. Helplessness may in turn lead to hopelessness about the future, which promotes further depression
What parts of the brain are most often connected with anxiety? What is the behavoiural inhibition system?
neural circuits related to potential threat and fear conditioning—the hypothalamic-pituitary-adrenal (HPA) axis; the limbic system (amygdala, hippocampus), which acts as a mediator between the brain stem and the cortex; the ventrolateral and dorsolateral prefrontal cortex; and other cortical and subcortical structures Potential danger signals are monitored and sensed by the more primitive brain stem, which then relays the signals to the higher cortical centers through the limbic system - called behavoiural inhibition system
Does asking someone if they are thinking about suicide increase the risk ? Asking if they have a plan?
no
When treating someone with phobia should you say it will be ok?
no - say what's the wors that could happen - take it to the illogical conclusion
What are the differences between selective mutism and SOC?
nonverbal social engagement and oppositional features occur in selective mutism, but less so in SOC
Why might Chris Hadfield have a false sense of security?
odds catastrauphic accident 1/35 - spent 20 years having exposure therapy so not worried
What is active listening?
offers empathy and builds therapeutic alliance Reflect content / Reflect feelings Ensures client is heard and directs goal setting
According to twin studies what proportion of the variance in childhood anxiety is accounted for by genetic factors?
one-third or more However, identical twin pairs do not typically have the same types of anxiety disorders However, identical twin pairs do not typically have the same types of anxiety disorders
What are the most common co-occuring disorers with selective mutism?
other anxiety disorders, particularly SOC and specific phobia. Oppositional behaviors may also occur, but these may be limited to situations in which the child is required to speak
What si the prevelence of panic attacks and agoraphobia?
panic attacks are common among nonreferred adolescents, affecting about 16% of teens PD and agoraphobia are much less common, with an estimated lifetime prevalence for both of about 2.5% for youths 13 to 17 years of age - panic attacks much more common than pd and agoraphobia
What is the purpose of anxious vigilance?
permits the child to avoid potentially threatening events by early detection, with minimal anxiety and effort. Although this may benefit the child in the short term, it has the unfortunate long-term effect of maintaining and heightening anxiety by interfering with the information-processing and coping responses needed to learn that many potentially threatening events are not so dangerous after all
What symptoms of ADHD are often seen in those with BP? What is the comobidity of these disorders?
poor judgment, distractibility, inattention, irritability, hyperactivity, anger, poor impulse control, demanding behaviors, and the tendency to jump from one topic or activity to another 60% to 90% of prepubertal children and 30% of adolescents also have ADHD
What are some of the rsik factors for BP discussed inthe text? (6)
poor maternal health or nutrition during pregnancy, substance use during pregnancy, a stressful early environment, exposure to traumatic events, and parental mood disorders
What are the 6 stages of change?
precontemplation contemplation preparatoip action maintenace relapse (know general idea)
What are some normal ritualistic behaviours in young children?
preferences for sameness in the environment (e.g., watching the same DVD over and over again), rigid likes and dislikes, preferences for symmetry (e.g., carrying a toy in each hand), awareness of minute details or imperfections in toys or clothes (e.g., being bothered by a minuscule thread on a jacket sleeve), and arranging things so they are "just right" (e.g., insisting that different foods not touch each other on the plate).
What is Body Dysmorphic disorder?
preoccupation with defects or flaws in physical appearance that are not observable or appear slight to others.
What types of parenting practices tend to lead to anxiety?
rejection, overcontrol, overprotection, and modeling of anxious behaviors parents of children with anxiety disorders were found to grant less autonomy to their children than other parents; mothers more likely to be critical and to be less positive when interacting with their children Emotional overinvolvement by parents is also associated with an increased occurrence of SAD in their childre
What is emotion regulation? How does it relate to depression?
processes by which emotional arousal is redirected, controlled, or modified to facilitate adaptive functioning and the balance maintained among positive, negative, and neutral mood states Children's strategies for self-regulation play a crucial role in overcoming, maintaining, or preventing negative emotional states. As we have discussed, young children who experience prolonged periods of emotional distress and sadness, or who are exposed to maternal negative moods, may have problems regulating negative emotional states and may be prone to the development of depression may use avoidance or negative behavior to regulate their distress, rather than more problem-focused and adaptive coping strategies. Since emotion regulation encompasses neurobiological regulatory processes, acquired behavioral and cognitive strategies, and external resources for coping, depression may result from difficulties in any one or more of these areas
How does SAD progress?
progresses from mild to severe. It may begin with harmless requests or with symptoms such as restless sleep or nightmares, which progress to the child sleeping nightly in his or her parents' bed. Similarly, school mornings may evoke physical symptoms and an occasional absence from school, which escalates into daily tantrums about leaving for school and outright refusal. The child may become increasingly concerned about the parents' daily routine and whereabouts
What are the lifetime prevelence rates of BP in youth 7-21?
range from about 0.5% to 2.5% worldwide - it is possible that BP in young people is more common and occurs at a younger age than previously thought - hard to diagnose
How common is depression among preschool aged children
rare - 1-2%
What is fear of school really a fear of?
really a fear of leaving their parents—separation anxiety
What are the two distinct categories of young children's routines?
repetitive behaviors and doing things "just right." categories are strikingly similar to those found for older individuals with OCD and related disorders
What is required to diagnose a child with selective mutism?
require that the child's disturbance interferes with educational or work achievement or with social communication, that it is present for at least 1 month, that it is not limited to a lack of knowledge or discomfort with the spoken language required in the social situation, that it is not better explained by a communication disorder, and that it does not occur only during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder
What is needed for a diagnosis of BP I Disorder?
requires evidence for a manic episode and one or more major depressive episodes;
What do we tend to see in children with early onset OCD?
rly age at onset of OCD (6 to 10 years) are more likely to be boys and more likely to have a family history of OCD than children with a later onset, suggesting a greater role of genetic influences in such cases These children have a high rate of co-occurring chronic tic disorders (Piacentini et al., 2014), trichotillomania (hair loss from compulsive pulling or twisting of hair), and ADHD
How do kids with anxiety disorders tend to view themselves?
see themselves as shy and socially withdrawn and to report low self-esteem, loneliness, and difficulties in starting and maintaining friendships
When are anxiety disorders most likely to be associated with difficulty making friends?
see themselves as shy and socially withdrawn and to report low self-esteem, loneliness, and difficulties in starting and maintaining friendships
What are the most common and effective medications used to treat anxiety? For which disorder are they most successful? What is an example of a type of these medications?
selective serotonin reuptake inhibitors (SSRIs) - strongest evidence of their effectiveness is in treatment of OCD Zoloft, prozac
What are the most frequent symptoms of anxiety in children with normal anxieties?
separation anxiety, test anxiety, overconcern about competence, excessive need for reassurance, and anxiety about harm to a parent
How have studies implicated serotonin in anxiety?
serotonin system associated with BI, particularly among those who are also exposed to environmental risk of interest because the serotonin system has been implicated in anxiety and is the site of action for widely used antianxiety and antidepressant medications
What is participant modeling and reinforced practice?
sing this procedure, the therapist models the desired behavior (e.g., approaching the feared object), encourages and guides the child in practicing this behavior, and reinforces the child's efforts. Although all exposure procedures are effective, real-life, or in vivo exposure, works best—but it is not always easy to implement. Once the child faces her fear in a real-life situation with no adverse consequences, she is more confident about doing it again
What is Excoriation Disorder?
skin-picking disorder) is characterized by recurrent skin picking resulting in skin lesions
What other effects are seen in youth with BP?
sleep disturbances, disrupted relationships with family and peers, risk-taking behaviors, and medical problems such as overweight status or obesity, cardiovascular and metabolic disorders, epilepsy, and migraine headaches
How do we treat thought errors?
slow down and pay more attention so will notice the error
What is a social anxiety disorder? What is another name for this?
social phobia Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), or performing in front of others (e.g., giving a speech). Note: In children, the anxiety must occur in peer settings and not just during interactions with adults. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others). The social situations almost always provoke fear or anxiety
Why are social skills training so important for youth with depression?
social withdrawal is a key perpetuating symptom
What is physiological hyperarousal? How does it relate to anxiety?
somatic tension, shortness of breath, dizziness may be unique to children who are anxious. Although this hypothesis has received some support, particularly with respect to panic disorder, fewer studies have investigated this construct and findings have been inconsistent
What are the two styles of depressed mothers? How does this affect their children?
some are more intrusive and others are more withdrawn. These differences are important because they may be associated with different child outcomes. For example, children of depressed mothers with an intrusive maternal style display avoidance and "tuning out," whereas children of depressed mothers with a withdrawn maternal style display heightened sociability toward strangers cope with the unpredictability of their environment in different ways, which are often maladaptive and show reactions ranging from aggressive behavior to withdrawal, failure to thrive, school refusal, depression, and even suicidal behavior
What are SMART goals?
specific measureable attainable relevant time bound
What phsyical symptoms are common with GAD, PD & SAD?
stomachaches or headaches
What have brain scans of children with GAD found?
suggest abnormalities (larger volume) in brain regions and circuits associated with social-emotional information processing and fear conditioning (amygdala and superior temporal gyrus) more pronounced right-left hemisphere brain asymmetries in children with GAD, which have also been reported in children who are behaviorally inhibited or anxious/depressed
What do we tend to see with supporession of of OCD tendencies?
suppression commonly has a rebound effect, with increased symptoms once the child is in a safe place. As the child becomes too overwhelmed by anxiety to cope, or when websites, magazine articles, or TV shows about OCD bring the problem into focus, others become more and more aware of its seriousness
how has the number of youth diagnosed with BP changed in since the 90's?
the estimated number of youth outpatient office visits for BP has increased at least 40-fold, with about 90% of the youngsters receiving prescriptions for psychotropic medication during these visits
What will effect likelihood of GAD symptoms persisting over time?
the likelihood of their having GAD at follow-up was higher if symptoms at the time of initial assessment were severe
What is school refusal behaviour?
the refusal to attend classes or difficulty remaining in school for an entire day. It includes youngsters who resist going to school in the morning but eventually attend, those who go to school but leave at some point during the day, those who attend with great dread that leads to future pleas for nonattendance, and those who miss the entire day
Why does research that supports the influence of the seritonin transporter gene on depression need to be interpretted with caution?
there have been few studies with children and that results have been inconsistent. Thus, findings in this area, particularly those for the serotonin transporter gene, must be viewed cautiously until they can be confirmed in studies that consider how multiple genes interact with multiple sources of environmental adversity in youngsters with and without depression
What is catastrophizing and how does it relate to anxiety?
thinking that something is far worse than it actually is cognitive coping strategies rely more on catastrophizing and rumination and less on positive reappraisal and planning children with anxiety disorders see themselves as having less control over anxiety-related events than do other children
How doee threatening life events effect anxiety and depression?
threatening life events such as physical jeopardy or the risk of losing a parent are related to symptoms of anxiety but not of depression. In contrast, life events involving actual loss and stress, such as the death of a family member or family stress, are associated with depression but not anxiety
are medications as successful for youth as for adults?
tricyclic antidepressants have not proven to be nearly as effective for depressed young people as for depressed adults . In contrast, newgeneration antidepressants, especially the selective serotonin reuptake inhibitors (SSRIs), have demonstrated moderate efficacy in controlled studies with young people
How do genes contribute to BP?
tudies have identified several chromosomal regions and susceptibility genes specific genes that have been identified contribute only a small amount to the risk for BP. In addition, several of these genes have also been identified for youths with depression, anxiety, ADHD, or psychosis. There is likely a complex mode of inheritance rather than a single dominant gene. Individuals with a genetic predisposition do not necessarily develop BP, since environmental factors also play an important role in determining how genes are expressed
What proportion of kids with SAD have another disorder?
two-thirds of children with SAD have another anxiety disorder, and about half develop a depressive disorder following the onset of SAD. They may also display specific fears of getting lost or of the dark. School reluctance or refusal is also quite common in older children with SAD
How is intelligence related to anxiety disorders and OCD?
typically have normal intelligence, and there is little evidence of a strong relationship between anxiety and IQ excessive anxiety may be related to deficits in specific areas of cognitive functioning, such as attention, memory, and speech or language - can interfer with academic performance specific mechanisms involved could include anything from frequent absences to direct interference on cognitive tasks such as taking a test or solving a math problem. Youth with anxiety disorders, particularly SOC, may also fail to reach their academic potential because they drop out of school prematurely
What is the duration requirement from the DSM-5 for manic symptoms?how is this problematic?
uration of manic symptoms in young people often does not meet the DSM-5's distinct 1-week duration requirement to be a manic episode. In an epidemiological study of 8- to 19-year-olds, it was found that recurrent episodes of mania or hypomania that met the DSM-5 criteria for episode duration were extremely rare (<0.3%), and restricted to 16- to 19-year-olds
What are some predictors of a poorer outcome for those with OCD?
younger age at onset of OCD, a poor initial response to treatment, hoarding symptoms in childhood, a lifetime history of tic disorder, and parental psychopathology at the time of referral
What is the classical psychoanalitic theory of anxiety?
views anxieties and phobias as defenses against unconscious conflicts rooted in the child's early upbringing. Certain drives, memories, and feelings are so painful that they must be repressed and displaced onto an external object or symbolically associated with the real source of anxiety. anxiety and phobias will protect the child against unconscious wishes and drivesagainst unconscious wishes and drives
What is the gene--environment interaction of depression? What support is there for this?
vulnerability to negative affect may be inherited and that certain environmental stressors may be required for these vulnerabilities to result in depression 3-year longitudinal study found that the effects of family conflict on depressive symptoms were greater for children and adolescents at genetic risk for depression study found that individuals with variants in the serotonin transporter gene displayed more depressive symptoms, diagnosable depression, and suicidality in relation to stressful life events than those who did not higher risk for depression in children who were maltreated, but only in children with variants in both the BDNF and serotonin transporter genes. Importantly, social support was also found to ameliorate the child's genetic risk for depression
How can too much trauma early in life result in behavioural inhibition?
will use up all the cortisol
How do kids with GAD tend to relate to others?
worry may lead to significant interpersonal problems, especially those involving a tendency to be overly nurturing to others. D seek constant approval and reassurance from adults and fear people whom they perceive as unpleasant, critical, or unfair. They tend to set extremely high standards for their own performance and are highly self-critical when they fall short
What is meta-worry?
worrying about worry, involves the development of beliefs such as worrying is uncontrollable or that it can lead to negative consequences for the worrier. For children with GAD, these negative beliefs about worry may lead to even higher levels of anxiety and more widespread anxiety
Does one parent having a phobia increase the likelihood of a child having a phobia? Why?
yes can be attributed to both genetic and environmental factors.
Do ethnic minorities experience more anxiety?
yes symptom expression, biological factors, and family processes may differ somewhat by ethnic group African American children generally report more symptoms of anxiety than do white children whites are more likely to present with school refusal and with higher severity ratings than African Americans. It has been found that symptoms of anxiety are higher in children of parents with fewer years of formal education, suggesting that variations in child anxiety across racial/ethnic groups may also be accounted for by group differences in parental education
How do the obsessions of young children commpare to those of older children?
young children indicates that they typically have obsessions that are more vague than those of older children and are less likely to feel that their obsessions are abnormal. Young children with OCD often ask their parents endless questions related to their obsessions and make no effort to hide their discomfort. Most children over 8 years of age are aware that their obsessions are abnormal, and they are usually uncomfortable talking about them. They may try to hide or minimize them or deny they have them, which frustrates parents who know that something is wrong and want to help.
What are the 5 types of physical anxiety?
▲ Chemical effects. Adrenaline and noradrenaline are released from the adrenal glands. ▲ Cardiovascular effects. Heart rate and strength of the heart beat increase, readying the body for action by speeding up blood flow and improving delivery of oxygen to the tissues. ▲ Respiratory effects. Speed and depth of breathing increase, which brings oxygen to the tissues and removes waste. This may produce feelings of breathlessness, choking or smothering, or chest pains. ▲ Sweat gland effects. Sweating increases, which cools the body and makes the skin slippery. ▲ Other physical effects. The pupils widen to let in more light, which may lead to blurred vision or spots in front of the eyes. Salivation decreases, resulting in a dry mouth. Decreased activity in the digestive system may lead to nausea and a heavy feeling in the stomach. Muscles tense in readiness for fight or flight, leading to subjective feelings of tension, aches and pains, and trembling
What are the 4 primary problems treatments for anxiety aim to modify?
▲ Distorted information processing ▲ Physiological reactions to perceived threat ▲ Sense of a lack of control ▲ Excessive escape and avoidance behaviorsexplosure
What are the three things the ACTION Program focuses on?
▲ Dysphoria, anger, anhedonia, and excessive anxiety are treated by educating the child about the relation between mood, thinking, and behavior, and by using anger management procedures, scheduling pleasant activities, and relaxation training. ▲ Interpersonal deficits are treated using social skills training. ▲ Cognitive distortions and negative and selfcritical thinking are addressed by using cognitiverestructuring procedures and training in effective problem-solving and self-control procedures
What are the 4 other criteria needed for a diagnosis of Major depressive disorder?
(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 to another medical condition. Note: Criteria A-C represent a major depressive episode. Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual's history and the cultural norms for the expression of distress in the context of loss. (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 hypomanic episode. Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.
What poportion of kids who think about suicide actually attempt it? What are the most common methods of attempted suicide?
1/3 - Drug overdose and wrist cutting are among the most common methods Suicidal ideation (e.g., thinking about killing oneself) is common across many different types of psychological disorders, but actual suicide attempts are much more common during depression
What is anaclitic depression? When was this term first used? What was this attributed to?
1940s, American psychoanalyst René Spitz described a condition he called anaclitic depression, in which infants raised in a clean but emotionally cold institutional environment displayed reactions that resembled depression displayed weeping, withdrawal, apathy, weight loss, and sleep disturbance. They also showed an overall decline in development, and in some cases, death attributed this depression to an absence of mothering and the lack of opportunity to form an attachment, other factors, such as physical illness and sensory deprivation, may also have played a role
Why is there an increase in depression from preschool to elemtary school to
reflection of the school-age child's growing self-awareness and cognitive capacity, verbal ability to report symptoms, and increased performance and social pressures
What percent of youth with clinical depression have thoughts of suicide? What percent attempt it by 17 years of age
About 60% of youngsters who are clinically depressed report having thoughts about suicide, and 30% attempt suicide by 17 years of age, with most attempts coming within the first year after the onset of suicidal thoughts. Unfortunately, about half of them eventually make further attempts they are symptom-free—90% or more have depressive features at the time of their suicidal episode. Finally, among youngsters who kill themselves, the odds of having major depression are 27 times higher than among control
How does social support differ for kids with P-DD and MDD?
Adolescents with a history of P-DD report receiving less social support from friends. This finding appears to be unique to children with P-DD as compared with children with MDD Those who recover from their P-DD have the same family relationships, cognitive styles, and school functioning as other children. The only area that continues to be affected is psychosocial functioning owever, it is not known whether deficits in psychosocial functioning precede or follow P-DD. They may be a predisposing factor for the development of P-DD, or a lasting scar of the illness
What is the likley outcome for kids with P-DD?
Almost all children eventually recover from P-DD. On the other hand, they also have an extremely high risk of developing other disorders, especially MDD, anxiety disorders (separation anxiety disorder and generalized anxiety disorder are the most common), and conduct disorder increased risk for the subsequent development of bipolar and substance-use disorders
is depression in young people common?
Almost all young people experience some symptoms of depression, and many experience significant depression at some time Suicidal behavior among teens, which is frequently associated with depression, is also a very serious concern
How does self-esteem relate to depression?
Almost all young people with depression experience negative self-esteem. In fact, low self-esteem is the symptom that seems most specifically related to depression in adolescents Self-esteem in children with depression is also highly reactive to daily life events, and such daily fluctuations in self-esteem appear to be related to depression following exposure to major life stresses both low self-esteem and unstable self-esteem seem to play an important role in depression Since physical appearance and approval from peers are especially important as sources of self-esteem for most adolescents, perceived incompetence in these areas may heighten the risk for depression. The fact that self esteem problems in adolescent girls are often related to a negative body image may partly contribute to their higher risk for depression
What percent of youth aged 4-18 experience MDD each year?
Between 2% and 8% relatively rare among preschool and school-age children (about 1% to 3%) increases twofold to threefold by adolescence Lifetime prevalence estimates— whether a young person has ever been depressed—range from about 10% to 20% or higher
Until what age is depression in childrn difficult to diagnose? What have studies shown about this?
Depression in children under the age of 7 is diffuse and less easily identified. However, some studies have found that age-adjusted diagnostic criteria can be used to identify and treat depression in children as young as 3 to 5 years
What are the 9 symptoms that need to present for a diagnosis of Major depressive disorder? How many need to be present? For how long?
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. Note: Do not include symptoms that are clearly attributable to another medical condition. (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 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 gains). (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 selfreproach 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.
When do suicide attempts decline? Why?
In adolescents with depression, suicide attempts double during the teen years but show an abrupt decline after age 17 or 18. It is possible that as young people mature, they are better able to tolerate their negative mood states and acquire more resources for coping, thus making it less likely that they will attempt suicide during periods of sadness
In females which ethnicity has the highest rates for depression? Men?
In females, initial rates of depressive symptoms were highest for Hispanic and Asian teens and lowest for whites, with African American youths falling in between. As expected, males displayed lower levels of symptoms, but the findings for race-ethnic group differences were similar to those for females. Within gender, all groups showed decreases in symptoms over time; however, whites continued to display fewer depressive symptoms than the other three groups, particularly as compared with African Americans. This lasting race-ethnic inequality in depressive symptoms creates a risk for emotional and physical health in later life, as stress may accumulate in the context of a lack of resources.
What is the primary strategy for reducing suicide in young people?
In light of the strong connection between symptoms of depression and suicidal ideation and behavior, a primary strategy for reducing suicide in young people is to increase the availability of effective treatments for depression
What happens in teen years that may makegirls at a higher risk for depression?
Many physical, psychological, and social changes during adolescence may heighten the risk for depression in girls. Hormonal changes in estrogen and testosterone may affect brain function, increasing sexual maturity may affect social roles, interpersonal changes and expectations may result in heightened exposure to stressful life events, and nonnormative changes such as early maturation may lead to isolation from one's peer group changes may diminish self-worth, lead to depressed mood, and evoke self-focused attention. It is also thought that girls may be at higher risk than boys because they have a greater orientation toward cooperation and sociality. They also use ruminative coping styles to deal with stress (focusing on the symptoms of distress and its causes rather than on solutions)—especially stress involving interpersonal loss and disruptions. These two characteristics may put girls at a disadvantage during adolescence, when they face somewhat greater biological and stressful role-related challenges than boys
Why is the presense of sad mood, diminised interest or pleasure, or irritability essential for diagnosing depression?
Many symptoms and behaviors may also occur in children and teens who are developing normally or in those with other disorders or conditions - regardless of the child's age, the symptoms must reflect a change in behavior, persist over time, and cause significant impairment in functioning
How do attrubutions of failure and negative beliefs relate to depression?
Negative beliefs ("I never do nothing right.") and attributions of failure ("I'm a total failure.") are not part of the diagnosis but typically accompany the disorder. Negative thoughts that are self-critical and automatic, such as "I'm a real loser," "I'm ugly," or "I'm gonna fail," are common. Unfortunately, these thoughts can't simply be swept aside by suggesting to a depressed youth that she or he "look at the bright side.
Why do depressive episodes re-occur, and why does the length of time between episodes get progressively shorter? What is this process known as?
One possible explanation is that the first episode may sensitize the child to future episodes - the first episode may be linked to a specific stressor and is accompanied by lasting changes in biological processes that heighten future reactivity to stress The initial externally produced changes in the brain can be conditioned so that following the first depressive episode, individuals are increasingly vulnerable to stress, and even nonsevere stress or minor events that resemble loss or stress experiences may result in depression This process is known as stress sensitization
How does brain activity differ in boys and girls with depression?
One study of blood flow in regions of the brain during periods of sadness in men and in women found that although men and women considered themselves to be equally sad, their brain activity differed. When asked to feel sad on cue, both sexes activated regions of the prefrontal cortex, but women showed a much wider activation of the limbic system
When does P-DD develop? How does this compare to MDD? What is the average duration?
P-DD develops about 3 years earlier than MDD, most commonly around 11 to 12 years of age Since P-DD frequently precedes MDD, it could be a precursor to its development 2-5 years
How does prevalence of P-DD compare to MDD? What is the most common co-occuring diagnosis? What other disorders tend to occur with it?
Rates of P-DD are lower than those of MDD, with approximately 1% of children and 5% of adolescents The most prevalent co-occurring diagnosis with P-DD is MDD. During the course of their P-DD, as many as 70% of children may have an episode of major depression anxiety disorders, CD, and ADHD
Who tends to have more serious depression?
Those with an onset of depression prior to age 15 and a recurrent episode prior to age 20 display more severe, chronic, suicidal depressions; greater co-occurring anxiety and worse social functioning at age 15; and poorer psychosocial outcomes at age 20 For youths who are hospitalized for depression, nearly half will be rehospitalized within 2 years after remission
Why was it thought for a long time that children didn't get depressed? (3 reasons)
When children become sad, irritable, or upset, parents often attribute the negative moods to temporary factors—such as a lack of sleep or not feeling well—and expect the moods to pass - what does she have to be depressed about attitude towards kids rooted in traditional psychoanalytic theories, which viewed depression as hostility or anger turned inward. Because children lacked sufficient superego development to permit aggression to be directed against the self, it was believed that they were incapable of experiencing depression symptoms of depression were considered normal and passing expressions of certain stages of development
What is mood?
a feeling or emotion - eg anger, sadness, elation etc
Why are there concerns with using DMDD to diagnose?
absence of data about its prevalence, course, and response to treatment. A central concern is the extent to which the criteria developed for DMDD can be used to reliably differentiate it from other mood and behavior disorders, particularly ODD, which as you may recall, also includes irritability, anger, and defiance as key features field trials report overall reliabilities of the DSM-5 criteria for DMDD in clinical practice to be quite low
What domains do youth tend to look for feedback on? What is this feedback used for?
academics, social relations, sports, conduct, and physical appearance Self-views are constructed from this feedback, and the outcome may be a varied and positive self-view leading to optimism, energy, and enthusiasm. Or it may be a narrow and negative self-view leading to pessimism, a sense of helplessness, and possibly, depression Children whose self-views are negative and narrowly focused in one domain—for example, in academics— may show instability in their self-esteem because they lack alternative compensatory areas of functioning, such as sports or social relations. This may make them vulnerable to developing depression when faced with stress in their primary domain
How is anxiety related to MDD?
an early-onset anxiety disorder is a strong predictor of later depression and precedes depression in 85% of young people with both disorders - multiplepathways model for understanding the strong relationship between anxiety and depression - one common pathway, the child may have a general propensity (temperamental, biological, environmental) to anxiety - If left untreated, this may lead to anxiety-related impairments (e.g., cognitive biases, negative affectivity) that become risk factors for the development of depression
What are some of the common disorders that occur with depression? (5)
anxiety disorders, Persistent depressive disorder, conduct problems, attention- deficit/ hyperactivity disorder (ADHD), and substance-use disorder are also common in youngsters with MDD
Why is there an increase in depression from school-age to teens? What evidence of this is there?
appears to be the result of biological maturation at puberty interacting with important developmental changes that occur during this tumultuous period supported by the emergence of large sex differences in depression after puberty, the emergence of bipolar disorder, and the relative stability in rates of depression through adolescence
What percent of kids with MDD have a co-existing disorder? Which is most common?
as many as 90% of young people with depression have one or more other disorders, and 50% have two or more anxiety disorders, particularly generalized anxiety disorders, specific phobias, and separation anxiety disorders Depression and anxiety become more visible as separate but co-occurring disorders as the severity of the child's problem increases and as the child gets older
Is there a link between depression and IQ?
association between severity of depression and children's overall intelligence is weak, suggesting that the effects of depression on cognitive functions may be selective. For example, depression may be associated with impairments while performing nonverbal tasks that require attention, coordination, speed, or recall of emotionally coded information, such as facial expressions but not necessarily on tasks that require verbal skills or overall intelligence
What is disruptive mood dysregulation disorder (DMDD)? What are the two major features?
chronic, severe persistent irritability. This severe irritability has two main clinical features. The first is frequent verbal or physical temper outbursts that usually occur in response to frustration and are totally out of proportion to the provocation or situation. These outbursts must occur frequently (three or four times a week) over 1 year in at least two of three settings (i.e., at home, at school, with peers), and must be ageinappropriate. The second feature of severe irritability is a chronic, persistently irritable or angry mood that is present most of the day, nearly every day, between the severe temper outbursts. This mood must have an onset prior to age 10 years; be characteristic of the child; be present most of the day, nearly every day; and be noticeable to others.
According to the DSM-5 where is DMDD most common? What is it related to?
clinic samples, occurs predominantly in males and in schoolage children, has high comorbidity with anxiety, mood, and disruptive behavior disorders, and markedly disrupts the youth's family and peer relationships and school performance.
What is depression as a disorder? What are the 3 major types? Describe each
comes in 3 types major depressive disorder (MDD), has a minimum duration of 2 weeks and is associated with depressed or irritable mood, loss of interest or pleasure, other symptoms (e.g., sleep disturbances, difficulty concentrating, feelings of worthlessness), and significant distress or impairment in functioning persistent depressive dis- order [P-DD], or dysthymia, is associated with depressed or irritable mood, generally fewer, less severe, but longer-lasting symptoms (a year or more in children) than MDD, and significant impairment in functioning disruptive mood dysregulation disorder (DMDD), is a recently introduced depressive disorder characterized by: (1) frequent and severe temper outbursts that are extreme overreactions to the situation or provocation; and (2) chronic, persistently irritable or angry mood that is present between the severe temper outbursts
How does social withdrawal relate to depression?
common often spend significant amounts of time alone, show little interest in seeing friends, and engage in few activities. Their social withdrawal may reflect an inability to maintain social interactions—possibly related to negative, irritable, and aggressive behavior toward others—and deficits in initiating conversations or making friends can seriously interfere with social development, depriving youngsters with depression of the social exchanges that lead to healthy interpersonal relationships.
How does depression during the school year relate to other negative outcomes?
increases the risk for later delinquency, tobacco use, substance-use disorder, suicidal behavior, impairment, school dropout, poor work record, marital problems, and health-service use
What symptoms tend to be seen in preteens and teens children whoa re depressed?
display many of the symptoms of younger children, in addition to increasing self-blame and expressions of low selfesteem, persistent sadness, and social inhibition - Feelings of isolation from family preteen may also experience an inability to sleep or may sleep excessively Disturbances in eating are also common. increased irritability, loss of feelings of pleasure or interest, and worsening school performance. Angry discussions with parents regarding normal parent-teen issues, such as choice of friends or curfew, are also more common, negative body image and self-consciousness, physical symptoms such as excessive fatigue and energy loss, feelings of loneliness, guilt, and worthlessness, and suicidal thoughts, plans, and attempts
What is irritability? How common is it?
easy annoyance and touchiness, characterized by an angry mood and temper outbursts Others may describe these children as cranky, grouchy, moody, short-fused, or easily upset. Being around them is difficult because any little thing can set them off one of the most common co-occurring symptoms of depression, present in as many as 80% of clinic-referred and 36% of community samples of youngsters with depression
What is 'depression's double standard'?
females are twice as likely as males to suffer from depression, are more susceptible to milder mood disorders, and are more likely to experience recurrent episodes
How did the definition of DMDD change over time?
first described as "severe mood dysregulation disorder," then as "temper dysregulation disorder," and lastly as a "disruptive mood regulation disorder." Significantly, it was also moved from the Disruptive, Impulse-Control, and Conduct Disorders section of DSM-5 to the Depressive Disorders section—not to the Bipolar Disorders section
What were the 2 contexts DMDD was formultated into?
first included findings on severe irritability as a salient characteristic of mood, not just as a manifestation of MDD - For example, studies have found that irritability at age 3 predicts depression, ODD, and functional impairment in early childhood and that irritability in adolescence predicts self-reports of depressive and anxiety disorders up to 20 years later second context was research on bipolar disorder (to be discussed later in this chapter) that identified children with severe mood dysregulation problems whose symptoms did not fit neatly into traditional definitions of bipolar disorder. Importantly, the development of the diagnosis of DMDD was a direct response to concerns about increasing rates of bipolar disorder diagnoses in young children and the growing use of medications to treat these children. Thus, much of the initiative in creating the category of DMDD was to provide an alternative to diagnosing BP in young children too frequently
What are the two pathways through which low social status of youth with depression emerges?
first pathway, depressive symptoms promote socially helpless behavior and subsequent neglect by peers. second pathway, depressive symptoms promote aggressive behavior and subsequent rejection by peers Chronic peer-related loneliness during childhood has also been found to predict depressive symptoms in early adolescence children with depression who report poor friendships at the time of referral have a reduced likelihood of recovery from depression
What are the two strongest risk factors for suicidal behaviour?
having a mood disorder and being a young female
How might an infant, preschooler, school-aged child, teen show depression? What does this suggest?
infant may show sadness by being passive and unresponsive a preschooler may appear withdrawn and inhibited school-age child may be argumentative and combative or complain of feeling sick teenager may express feelings of guilt and hopelessness, sulk, or feel misunderstood. likely represent different stages in the developmental course of the same process - Children express and experience depression differently at different ages
How did persistent depressive disorder (P-DD) change in the DSM-5? Why was this?
is a "new" category in DSM-5; it combines the previous DSM-IV categories of Dysthymic Disorder and MDD—Chronic done because of the lack of differences between youths with a dysthymic disorder and those with a chronic type of major depression. In comparison to nonchronic MDD, chronic forms of depression, whether referred to as dysthymic disorder, chronic major depression, or P-DD are associated with a poorer response to treatment, greater long-term morbidity at follow-up, and greater familial loading for affective disorders
What group do we know the least about depression?
know the least about depression in infants
How is the relationship betwen mothers, father, and siblings and youth with depression?
less supportive and more conflictual relationships with their mothers, fathers, and siblings than do children who do not have depression. They report feeling socially isolated from their families and prefer to be alone rather than with them youngsters may be quite negative toward their parents, and their parents in turn may respond in a negative, dismissing, or harsh manner. When repeated over time, these interactions may adversely affect family relationships. Children with depression who are irritable, unresponsive, and unaffectionate provide little positive reinforcement for their parents, and they frustrate their parents' desire for satisfaction in the parenting role
What is anhedonia?
loss of interest in nearly all activities
What symptoms tend to be seen in school-aged children whoa re depressed?
many of the symptoms of preschoolers in addition to increased irritability, disruptive behavior, temper tantrums, and combativeness - may look sad, but are often unwilling to talk about their sad feelings weight loss, headaches, and sleep disturbances. Academic difficulties and peer problems are also common, and may include frequent fighting and complaints of not having friends or being picked on. Suicide threats may also begin to occur at this age.
What are the most common methods of completed suicide?
most common methods are firearms (45%), suffocation (40%), and poisoning (8%)
what is co-rumination?
negative form of self-disclosure and discussion between peers focused narrowly on problems or emotions to the exclusion of other activities or dialogue seems to be one mechanism underlying adolescent females' heightened risk for depression. Ironically, co-rumination between peers is associated with higher ratings of friendship quality and closeness, which in turn, have been found to predict increases in co-rumination - what appear to be socially rewarding and supportive relationships with peers not only fail to protect female teens from distress, but also may increase their risk for depression when based on maladaptive styles of interaction
Has much research been done on ethnic, culteral, or racial differences in depressed youths? What has research found?
no not much One study compared the prevalence of MDD across nine ethnic groups in a large community sample of children in grades 6 to 8 frican American and Hispanic youths both had significantly higher rates of depression. However, only Hispanic youths with depression showed an elevated risk for impaired functioning. In another study, pubertal status was found to be a better predictor of depressive symptoms than chronological age in Caucasian girls, but not in African American or Hispanic girls imilarly, obesity in the sixth grade was found to be associated with a greater likelihood of depressed mood in the eighth grade for Caucasian girls but not for African American or Hispanic girls nonwhite (African American, Hispanic, and Asian) adolescents reported more symptoms of depression than white adolescents - hese differences likely reflect differences in socioeconomic status (SES), since depression and lower SES are related. - low SES may increase vulnerability to stress, and by doing so it may increase the likelihood of depression
What is the overall outcome predictions for those with depression?
not optimistic. Although almost all youths will recover from their depression, they continue to be at high risk for later episodes of mood and other disorders and for impaired social and academic functioning
Between what ages is there no sex differences in depression? What is the caveat to this?
not present among children ages 6 to 11, at which ages depression is reported to be equally common in boys and girls However, sex differences in emotional reactivity are present in children who are depressed or at risk for depression as early as the preschool period, with boys displaying more anger and girls more sadness sex differences in specific symptoms that forecast later depression (e.g., fearfulness, feelings of inadequacy, negative self-evaluation, and negative affect) may in fact be present prior to 10 years of age, with girls reporting significantly more of these symptoms than boys
What are self-injurious thoughts and behaviours?
range from nonsuicidal self-injury such as self-cutting, to suicidal ideation, suicide attempts, and completed suicide. Suicide is especially worrisome, as it is the second leading cause of death among adolescents and young adults in the United States, resulting in about 4,600 deaths per year
What are the two ends of the mood disorder spectrum?
one end = severe depression - dysphoria (state of prolonged bouts of sadness) - feel little joy anything, Anhedonia - some may never report feeling sad just very irritable other end = smaller number youth - experience episodes mania (an abnormally elevated or expanive mood, increased goal-directed acitivity and energy, and feelings of euphoria, which is an exaggerated sense of well-being.) -ongoing combinatino extreme highs and lows - called bipolar disorder or manic depressvie illness
How do kids with depression perform in school compared to those without?
perform more poorly than others in school. They score lower on standard achievement tests, are rated by their teachers as achieving less academically, and have lower levels of grade attainment Poor concentration and thinking ability, slowed movement or agitation, fatigue, insomnia, and somatic symptoms may lead to repeating a grade, being late or skipping school, failure to complete homework, and dissatisfaction with or refusal of school It is difficult to determine whether depression is a cause or an outcome of learning difficulties. Most likely it can be both - learning difficulties in adolescents, particularly girls, has been found to lead to feelings of inadequacy as a student, which predict depressive symptoms
What is depression? What is it sometimes called? Why? How is this different from 'feeling down'?
pervasive unhappy mood - Eeyore "the common cold of psychopathology" - bc symptoms of depression are so universal note - evreyone feels sad or down sometimes either for a specific reason (Eg losing job) or for no reason at all - difference is clinical depression is more severe than occasional blues or mood swings cannot seem to shake their sadness, and it begins to interfere with their daily routines, social relationships, school performance, and overall functioning may resemble the normal emotional dips of childhood, for many young people it is pervasive, disabling, long-lasting, and life-threatening
How does a pessimistic outlook relate to depression?
places them at greater risk for depressive symptoms, especially in response to stressful life events. Since their pessimism may continue after remission of depressive symptoms, they remain at risk for future depressive episodes.
What is the common characteristic of all depressive disorders? What are the differences?
presence of sad, empty, or irritable mood, along with somatic and cognitive symptoms that interfere with the individual's functioning differences among depressive disorders are related to their duration, timing, associated features, or presumed causes
What do suicide prevention and treatment programs focus on? Does this change depending on the cultural background
suicidal behavior generally focus on family involvement and support, and they emphasize intervening early after the suicidal crisis Since racial and ethnic groups are known to differ in rates of suicidal behaviors and the circumstances under which they occur (e.g., precipitants, risk and protective factors, and patterns of seeking help), it is also important that suicide prevention and treatment programs are sensitive to these cultural differences
What is depression as a symptom?
symptom - depression refers to feeling sad or miserable - often occur without the existence of a serious problem, and they are relatively common at all ages - most children, symptoms of depression are temporary, related to events in the environment, and not part of any disorder
How do symptoms of depression present in girls compared to boys?
symptom presentation is generally quite similar for the two sexes. (Slightly more girls than boys report symptoms related to weight and appetite disturbances and feelings of worthlessness and guilt depression is more highly related to schoolrelated stress in boys than in girls - correlates differ for the sexes
What is depression as a syndrome?
syndrome, depression is more than a sad mood - refers to a group of symptoms that occur together more often than by chance - represents an extreme on a dimension reflecting the number or severity of co-occurring symptoms that the child displays - occurrence of depression as a syndrome is far less common than isolated depressive symptoms, and it often includes mixed symptoms of anxiety and depression, which tend to cluster on a single dimension of negative affect
Why might reported rates of depression be too low?
the estimates using a DSM-5 diagnosis of MDD might be lower than the self-reported symptoms of depression many children who just barely fail to meet diagnostic criteria for MDD still show significant impairments in their social competence, cognitive attributions, coping skills, family relations, and experience of stress also at greater risk than other youths for developing future depression and other disorders, such as substance abuse
How does ODD and CD relate to MDD?
the extent to which young people with MDD experience oppositional defiant disorder (ODD) or conduct disorder (CD) seems to be directly related to the presence of irritable mood
When depression in childhood was acknowledged how was it thought of it comparisson to adults? What was the name for this? Is this true?
view emerged that children express depression in a much different way than adults, ways that are often indirect and hidden. This idea came to be known as masked depression thought that any known clinical symptom in children, including hyperactivity, learning problems, aggression, bed-wetting, separation anxiety, sleep problems, and running away, could be a sign of an underlying but masked depression not true - not masked just not as visible and often overlooked bc frequently co-occurring more visible disorders
What don't we know about DMDD?
whether DMDD as currently defined is distinct from other mood and conduct problems, its prevalence, characteristic course and outcomes, or how it can be best treated
What is persistent depressive disorder (P-DD)?
xperience symptoms of depressed mood that occur for most of the day, on most days, and persist for at least 1 year. They are unhappy or irritable most of the time - this is Eeyore Combined with their chronic depressed (or irritable) mood, these children also display at least two somatic (e.g., eating problems, sleep disturbances, low energy) or cognitive symptoms (e.g., lack of concentration, low self-esteem, feelings of hopelessness) that are present while they are depressed. Although the symptoms of P-DD are chronic, they are less severe than those for children with MDD
Do adopted children have a heightened risk for depression? In what other situation are the same symptoms likely to develop? What symptoms tend to be displayed?
young children exposed to institutional neglect and later adopted may display emotional and behavioral disturbances that place them at heightened risk for depression and other internalizing disorders similar symptoms could occur even in noninstitutionalized infants raised in severely disturbed families in which the mother was depressed, psychologically unavailable, or physically abusive. These infants may experience sleep disturbances, loss of appetite, increased clinging, apprehension, social withdrawal, crying, and sadness
are men or women more likely to have more suicidal ideation?
young females with depression show more suicidal ideation and attempt suicide more often than young males The risk factors for nonfatal suicide attempts are similar for males and females
