Final

PATHs curriculum

Promoting Alternative Thinking Strategies, increase social skills, delivered by teachers in classrooms, K-5th grade, better ways to solve problems, role playing,

-Self-blame -Guilt, survivor guilt -Shame/embarrassment because of trauma or symptoms -Hero fantasies related to trauma -Overgeneralization of danger/risk -Minimization of trauma -Foreshortened future -Magical thinking -Revenge fantasies (self, world, future, negative cognitive triad)

trauma-related cognitive distortions

Physical abuse Sexual abuse Emotional abuse Neglect

4 major types of maltreatment

resilience

A pattern of positive adaptation in the context of significant adversity, not placed solely on the person (sees the broader context), more than just inherent to the person, but does not give clear way to study/measure it, Not "invulnerability" / Not "ego-resiliency (someone able to bounce back from stress)" (not just within the person), NOT INVINCIBLE! wont always be fine, changed as the circumstances change, but does confir some success handling stress in the future requires 2 judgements: 1)doing ok in life (developmental tasks: have to be doing reasonably well, age salient tasks such as able to get along with peers, able to do well in school, not causing trouble, culturally defined, internal/external debate: often struggling internally even if doing well externally,) 2) serious threat to adaptation (stressful life event, need to have experienced a significant threat, chronic stress, accumulation of smaller stressors, variable and factors, what qualifies as trauma? controllable? related to choices people make? aspects of personality? predispose people to see things as less controllable and more stressful),

Other Specified Feeding or Eating Disorder (OSFED)

Clinically significant symptoms, but does not meet full criteria E.g., subthreshold symptoms for either or both AN / BN Possibly most common eating disorder; wide category

physical abuse

Definition from the World Health Organization (WHO): any act that results in physical harm resulting from an interaction that is within control of a parent or person in a position of responsibility, power, or trust. Vermont: permanent or temporary disfigurement or impairment of any bodily organ or function by other than accidental means

acute interventions

E.g. Child development policing program, Goals - psycho-education, triage and assessment, connect families to services

psychological debriefing

Group-based, No evidence for utility with children, May be harmful by increasing sensitivity to trauma among non-symptomatic children, not good evidence of effectiveness

tertiary prevention

Indicated level - targets individuals with disorder, to prevent further deterioration, not really prevention, designed to prevent further deterioration, more to do with physical medicine, diseases with decline, want to prevent and slow down as much as possible

community psychology

Intersection of clinical / counseling psychology, public health, sociology, social work, but paying special attention to the broader community

sexual abuse

Involvement of a child in sexual activity that he/she does not fully comprehend, is not able to give consent to, and that violates the laws or taboos of society. Vermont Statutes: incest, prostitution, rape, sodomy, or any lewd or lascivious conduct involving a child, including... [participation] in any photograph, motion picture, etc..." any sexual activity between an adult and a minor is illegal, gets fuzzy when the ages are of people close together (grey/difficult area), usually dealing with things that are damaging or concerning, pedophiles: think it is a problem with society and not them, if working with someone you are dealing more with the consequences of aftermath

binge eating disorder

Like bulimia, but without compensatory behaviors Importance of feelings of loss of control

neglect

Most common form of maltreatment, Failure to provide for a child in all domains: physical and mental health, education, nutrition, shelter, and safe living conditions, when the resources are reasonably available to the family or caretakers Vermont Statutes: "Failure to supply the child with adequate food, clothing, shelter, or health care...", does NOT include vaccines! (controversial!), usually seen in more than one domain,

bulimia nervosa

Recurrent binge-eating: Eating amount "definitely larger" than what most people would eat, in a short period of time sense of lack of control over eating during the episode Recurrent inappropriate compensatory behavior: E.g., induced vomiting, fasting, laxatives, excessive exercise Cycle of bingeing / purging happens on average weekly for three months Self-evaluation is unduly influenced by body shape / weight Not occurring exclusively during anorexia sometimes tricky where to draw the line (dieting is societally normative, try to draw the line between what is okay and what is unusual behavior that could put someone down a bad path)

Anorexia Nervosa

Restriction of energy intake leading to significantly low body weight for age and height Intense fear of gaining weight or of becoming fat, or behavior that interferes with weight gain, even though underweight Disturbance in how one's body weight or shape is experienced / undue influence of weight or shape on self-evaluation / denial of seriousness of low weight BMI cut offs (need to be under a certain weight), given as a diagnosis over bulimia if weight is low enough over control of eating, more severe than bulimia, if restricting food will not stay at a healthy weight very long,

secondary prevention

Selected level - targets individuals who are at risk, select at risk people, need to do a screening/assessment

psychological first aid (PFA)

Some emerging evidence for utility, Primarily psycho-educational, referrals to other places and psychoeducation, tailor to child with personal event, ways to get connection to child psych immediately after the event, partnership between social workers and psychologists, can be effective if done well, build rapport and get connection made for families that would not do this on their own, police learn psych and vice versa

compensatory factors

Stage 1 (reduced tolerance for stress and disinhibition of aggression): supportive spouse, SES stability, success at work and school, social supports and healthy models Stage 2 (Poor management of acute crises and provocation): improvement in child behavior, community programs for parents, coping resources Stage 3 (Habitual patterns of arousal and aggression with family members): parental dissatisfaction with physical punishment, child responds favorably to non-coercive methods, community restraints/services

primary prevention

Universal level - targets individuals who are not yet at risk, everyone is eligible to be given, doesnt distinguish between level of risk

trauma-focused CBT

Validated for 3-18 year olds Essential components: Establishing and maintaining therapeutic relationship with child and parent, Psycho-education about childhood trauma and PTSD, Emotional regulation skills, Individualized stress management skills Similar in many respects to Cognitive Processing Therapy introduced in PTSD lecture; create a narrative and reconstruct a narrative of the traumatic events, help work through consequences of a traumatic event, need to maintain the essential components, need to work on the cognitive distortions

poverty

bad risk factor example, natural experiment testing poverty and ODD/CD youth in western NC, followed for 4 years, 1/4 native american, high rates of poverty, midway through the study a casino opened on tribal land and gave money to the tribes on the land, increases in SES, created a natural experiment (manipulation of variables not done by the researchers), change in risk factor of income, outside event changed SES that had nothing to do with mental health, more direct correlation, 14% had a substantial increase in SES and moved out of poverty, significant change in ODD/CD symptoms (externalizing problems), paralleled in caucasian samples that moved out of poverty, about 3/4 of these effects had to do with parental supervision, parents in poverty stretched thin, higher SES allows for more time and energy to monitor kids, supervision and income effects, compelling evidence that poverty is more than a variable risk factor for ODD/CD (causal risk factor), aggregation of risk

NOT considered a mental disorder, but is coded as other conditions which may be a focus of clinical attention (V-code: in evaluation report/referral)

coding maltreatment (DSM)

-Some (mixed) evidence that maltreatment may affect global cognitive ability (IQ) (Overall differences between maltreated and non-maltreated youth are small) -Bigger differences seen in particular areas of reasoning: (Moral reasoning, Threat evaluation: not more accurate, hyperventilate, skew in what they see as a threat, Social information processing) -Evidence for perceived control as mediator between abuse and internalizing problems (ways to maintain a sense of control even if things are objectively out of control

cognitive effects of maltreatment

prevention science

come together across disciplines to come up with an intervention

bulimia - lack of control, emotional volitility, impulse control, ADHD

common comorbid disorders/personality characteristics associated with anorexia

George Albee

community psychology, drew attention to lack of provider issue, connected psychopathology to larger societal forces, primary prevention, found that given the data on job openings and epidemiology it is not possible to provide 1:1 interventions with everyone who needs it, larger societal factor focus (SES, neighborhood decline, racism), trained in part as clinical psychologist but paying special attention to the broader community, at this time there was a big divide between environmentalists and geneticists, led to decline in interest of broader impacts on mental health

Common comorbid disorders: Depression Anxiety (but less so than for anorexia) Substance use disorder (impulse control problems, the impulsivity appears earlier on in life) Course and outcome: Mixed, but better than for anorexia Some continue to show disturbed eating patterns, low self-esteem, depression even if no longer meeting full DSM-5 Bulimia (harder to get at underlying emotional problems than treating the healthier eating patterns) Poor prognosis if: Substance use history Longer duration before treatment

comorbid conditions for bulimia and course

-Psychological First Aid (PFA) -Psychological debriefing -Acute interventions

crisis intervention approaches for maltreatment

Masten 2001, ordinary magic

different risk factors and how they interact, issues of measurement, person vs. variable: different ways of analyzing data, if variable-centered: looking at entire sample and looking at effects across the entire sample, correlated with negative outcomes but protective factors = interactional effect. person-centered: take predictive power and combinations of variables to define subgroups in samples, look at descriptive differences between groups, isolate usually by outcome subgroup analysis vs analysis of entire sample

pica

eating dirt. building material, non-nutritious substances, environment is more chaotic and disruptive

-Sexual abuse predicted low self-esteem, but not necessarily peer problems -Emotional maltreatment was related to poor peer relationships, but not low self-esteem -Broad problems in emotion regulation (The ability to modulate or control the intensity and expression of feelings and impulses, marker but not end all be all, questionnaires, parent report, self-report) -Some evidence for gender specificity (I.e., abuse can be related to physical aggression for boys and relational aggression for girls) -Importance of looking at severity and chronicity of maltreatment (More severe / chronic physical abuse related to later aggression, both physical and relational, Severity of neglect related to later internalizing and withdrawn behaviors, related to seen differences, makes different by having many points of evidence)

emotional and behavioral effects of maltreatment

social information processing (SIP) model

encoding of cues --> interpretation of cues --> clarification of goals --> response access --> response decision --> behavioral enactment in maltreatment cant encode all the cues correctly and interpret things in a hostile way, able to generate appropriate responses and carry them out, have trouble at each step: can talk through all of them, pro-social responses and more confident in abilities to carry out that response, might need contextual changes on child's life

gender and age patterns, typical course Estimated at 0.3% of female adolescents Over 90% of diagnosed cases are female Question of under-diagnosis for males (conscious focus on weight in sports such as wrestling) Rarely begins before puberty; typical onset is late adolescence (but can usually see hints of it earlier on based on how people approach their relationship to food) Precursor: "pathological dieting" (doesnt occur out of nowhere) Generally chronic course (<half fully recover) High mortality (~5-20%, mainly cardiac problems or suicide) (once it starts its almost impossible to stop)

epidemiology Anorexia

Modal onset slightly later than anorexia (late adolescence into early adulthood) (later age of onset than anorexia, not same timing as puberty) More prevalent than anorexia ~3% of women for full DSM-5 bulimia Another 10% report some symptoms Again, population diagnosed is roughly 90%+ female

epidemiology of bulimia

FAST track program

families and schools together, school intervention with strong family aspect, intervention of anti-social behavior, often become violent criminals with low rates of rehabilitation, by age 10 already have a high degree of predictive power, put in place all over the country, randomized, control or intervention school, screening process in both, aggression screening, top 10% (about 3 kids, kids VERY high risk), both primary and secondary prevention, every class goth PATHs curriculum, at risk kids got EXTRA help: (Parenting groups, Child social-skills groups, Mentoring, Academic tutoring, Home visits, Peer pairing- need to be careful because can lead to both of them exhibiting the behavior), had effects (modest decrease in rates of conduct disorder, decrease in 10%) but not as much as they expected! justify the cost? most effects seen for severely aggressive youth, challenges of interventions and environmental disadvantage Motivation: Conduct problems are stable / persistent, high societal cost, Early-onset group at highest risk, Test developmental theories Basic design: Early, comprehensive, long-lasting, Four sites, 56 schools, Randomized to intervention vs. control by school, High-risk screening process, Top 10% on aggression questionnaire in kindergarten ran a screening process

Family factors ¡Overcontrolling / rigid style/limiting (risk factor, harsh punishment, hard to parse out personality or environment, reaction to parental control/modeling), DO NOT blame parents, want to communicate in a way that doesnt blame them because you need buy-in from the whole family Psychological factors / dimensions ¡Avoidance of harm (opposite of sensation seeking, not able to handle bad outcomes/cope) ¡Low novelty-seeking ¡High reward dependence (need for approval) at higher risk if these traits are present at age 11-12 Sociocultural factors ¡Body image ideals Anorexia as a "culture-bound syndrome", higher in modernized and westernized cultures/societies

family, psychological, and sociocultural factors related to anorexia

biological and psychological links: conducted during WW2 when recognition of wide spread malnutrition began to occur, if didnt want to be drafted could participate in research, lots of famine and malnutrition in concentration camps and in europe, wanted to know how to help/handle people who are malnourished, have to be gradual in the way you get nutrients back into the body, cut participant caloric intake in half, in good physical and mental health prior, after 6months of 1/2 caloric intake: significant psychological impacts, depression, psychotic symptoms (hallucinations, delusions), social problems, big part of anorexia, compounding psychological impact on the brain - more mood symptoms, psychological effects reversed when able to each normally again, aware of the need for early intervention/prevention, look out for disorganized eating, if intervene from first sign of eating problem have best chance of recovery, 2-3+ years with chronic anorexia highly unlikely they will ever get better/back to normal weight, at that point its all about preventing health complications and have to limit expectations of overall recovery ¡On average, participants lost ¼ of baseline body weight Results showed significant psychological impacts: ¡Depression, irritability, loss of concentration, social withdrawal

findings from minnesota starvation study and implications for anorexia

-Having told someone before a formal interview (series of interviews may be required!) Effective interviews -Experienced first abuse as adolescent

findings related to greater likelihood of disclosure of childhood abuse

Genetic factors ¡Heritability estimates: .5-.7 (personality traits e.g. perfectionism are heritable) ¡Genetics of Anorexia Nervosa Collaborative Study (trying to recruit a lot of people, 10-1000s of sample sizes for individual gene markers, also of relatives) ¡PROBLEM! Complexity of anorexia etiology generally not presented in the mainstream media Neurobiological factors ¡Likely minor role in ONSET, major role in maintenance ¡Possible role for disruption in serotonin systems in onset -tricky because causes a whole cascade of changed (effect instead of a cause, changes play a role in maintenance) differences in the ways brain areas activate to reward/food profound alterations in how see subsistence,

genetic and neurobiological factors related to anorexia

obesity

health epidemic, more about what people are eating, profile of food in the wider culture

some with a high number of risk factors still turn out okay, level of functioning of those with schizophrenia before the first psychotic break highly predictive of ability to somewhat recover, intergenerational studies of schizophrenia: higher risk for schizophrenia but also other psych disorders, many grew up to be fine, searched for things that inhibited development in those at risk, subgroup of kids that escaped diagnosis: started the research on resilience, dont have a lot of research on it., also different researchers define it differently, hard to get consensus

history of resilience research

¡National Incidence Study of Child Abuse and Neglect (Sedlak & Broadhurst, 1995) 3 million suspected cases each year in U.S. Between 1-1.5 million confirmed Neglect is biggest in terms of frequency if control for SES do not see significant differences based on age, race, and gender, but neglect does track with SES (neglect in theory means they have access/ability to get resources but isnt, alcohol and drug problems track with SES meaning they usually use the resources they can get but SES makes it difficult, any statistics that we do have are often under-represented sexual abuse is higher in females emotional abuse is less frequent than others (lower prevalence) because it is newer and harder to define (not a clear line)

incidence of maltreatment

crisis intervention approaches, trauma-focused CBT, parent training components (when appropriate, when not removed from the home and getting them to be compliant to not do it again, physical-building positive parenting skills, more common working with foster families due to still presenting aggressive behavior from past history)

interventions for maltreated youth

highly stigmatized and illegal: victims may not want to leave their homes and are often threatened that if they tell anyone they will have to leave faliability of childhood memory: especially for emotionally charged memories, often adults will say it never happened, but can look back at records and see it did happen, CPS rates are likely substantially underestimated (especially for emotional abuse): underfunded! can only investigate some of the things reported to them, make a report, call CPS, CPS takes the information and most of the time (suspected physical abuse or neglect) where it would take multiple reports to be considered for CPS intervention. Majority of sexual abuse victims do not disclose abuse during childhood Even in cases of well-documented abuse, children tend to minimize or not disclose Children can be vulnerable to suggestion, but this may be overstated in the media / popular imagination legal: need to be careful about how the assessments go, need to be boring, standard adjectives used, only write things that you can back up with specific evidence, children can be vulnerable to suggestion (implicit or explicit suggestion)

issues involving maltreatment reporting

cumulative risk gradients

linear relationship between the number of risk factors and externalizing problems, lack of access, often single mothers in shelters with children (not often fathers and have a lack of access to fathers), some have lower levels of externalizing problems (therefore better behaved) than the general population, homelessness itself (if stable and supportive family context) does not cause problems, but homelessness often confounds other risk factors, need to assess and mitigate risk, not all risk factors are equal but a lot of equated power of cumulative risk

Kauai study

longitudinal, 700 children, 1955, low geographic mobility, 30% high risk (4+ risk factors: pre/perinatal stress, chronic poverty, chronic interparental conflict, parental divorce, parental psychopathology), 2/3 of high risk group mention to have significant problems by age 10 (behavioral/emotional or learning problems), data collected prenatally, infancy, middle childhood, adolescence, adulthood, other 1/3 did okay, what differed?: easy going temperament, positive self-concept, aqueduct IQ/good problem solving skills (massive protective factor, based on society), social support/competent role models, can be people outside of caregivers (someone important to the child's life and has a real connection to the child), things that happen to the child as well as things that children have/bring to the table, kids have a sense that things are not right and seek out an outside context,

failure to thrive

lost of weight, listlessness

Medical complications: Cardiac arrhythmia, low blood pressure / heart rate Lethargy Dry skin, brittle hair Hypothermia Associated disorders / characteristics Depression / anxiety (causal direction?) Substance use disorder (binge-purge subtype only) Restricting: conformity, perfectionism, rigidity Purging: impulse control, emotionally volatile (when hospitalized, have no stalls and a lock on toilet flushes, beginning of larger intervention efforts,) (directionality between the associated disorders it unknown, depression could be due to effects of caloric restriction) perfectionist/rigid personality- high achieving/high SES, extreme pressure to succeed/do well/ look good, gives them control over a life they have no control over

medical complications associated with anorexia

Physical dangers / effects of vomiting ¡Erosion of tooth enamel ¡Dehydration ¡Swollen parotid glands ¡Low potassium Binges carry risk of ruptured stomach General GI disturbances

medical effects/complications of bulimia

emotional abuse

more recent, more fuzzy in terms of boundaries and state awareness of this abuse, Failure to provide a developmentally appropriate, supportive environment, so that a child can establish a stable and full range of emotional and social competencies "commensurate with his or her personal potential" Vermont Statutes: "pattern of malicious behavior which results in impaired psychological growth and development", NOT yelling/swearing at a child, pattern of prolonged malicious behavior (e.g. locked in closets, constantly insulted/belittled, over some period of time, pattern of behavior (often see this with other forms of maltreatment as well)

KEDS (Kid's Eating Disorders Survey)

national survey of 6,000+ adolescents, discussion about healthy body image, female percentages outpace males in a large factor, (%=%endorse something such as ever been on a diet), diet = conscious about what eating, promoting healthy eating habits, can become pathological in adolescent years,

-Very little direct research on children (obvious difficulties of access and controlling for other effects / context, need to take out the other contexts) -Animal stress models and adult PTSD research are highly suggestive (had 2 mice if had control blunted the negative impact, maltreatment is an uncontrollable stressor) (strong evidence that significant stress = dysregulation of the HPA axis, Disruptions in the HPA axis (elevated cortisol, hyper-reactive stress-response system)), can be long term -Elevated levels of norepinephrine (NE), dopamine (DA) -Some studies do show abnormal HPA-axis activity in childhood trauma survivors (e.g., sexual abuse) several years after the event -multiple brain systems involved in adaptive responses to stress, get hijacked in maltreatment especially if its chronic, physiological issues = heart problems -Overall: sensitization of brain systems that are designed to regulate adaptive responses to stress (e.g., "fight-or-flight")

neurobiological effects of maltreatment

feeding disorder of infancy

not feeding for whatever reason, pediatric psychology, trying to find any psychology on why not feeding/gaining weight typically, feeding is heavily evolutionarily likely, unusual when it doesnt happen how it normally should

risk factors

not making claims about the why these are factors just that they are statistically correlated with a negative outcome, variable, can be moderated by genetics, a characteristic, condition, or behaviour that increases the likelihood of getting a disease or injury, often presented individually, however in practice they do not occur alone. They often coexist and interact with one another

primary and secondary prevention combined

not mutually exclusive, certain components are universal (cheaper, group setting), certain parts are selected (parts that need to be individual), try to get the greatest good but cant do it for everyone, more intense interventions don't have enough resources for everyone, needs to be as cost effective as possible

eating disorders

not usually seen in younger children, more common in adolescents, fear of gaining weight

protective factors

often at the opposite end of risk factors, e.g. high IQ, high SES, some dont have an analog to risk, something activated in stress that helps in some ways, can be moderated by genetics, conditions or attributes (skills, strengths, resources, supports or coping strategies) in individuals, families, communities or the larger society that help people deal more effectively with stressful events and mitigate or eliminate risk in families and communities

-Selective attentional bias towards angry faces (Physically abused children show faster reaction time in, but have difficulty "disengaging" from, presentation of angry faces in a computer-based task, Represented attentional "benefits" on valid angry trials, learned to be aware of angry faces sensitivity born from controlled manner, benefit = when angry leads to danger/threat, need to be aware of this, but it drains attention and resources because they cannot disengage from the angry face) -Follow-up work: increased attention to threat-relevant stimuli may mediate relationship between abuse and anxiety (Lab-analogues studies involving fake arguments, had fake arguments in the next room and measured GSR and EEG responses, increased anxiety)

perceptual biases resulting from maltreatment

program/intervention

prevention, need to design a policy

eating an excessive amount in a short period of time (often unhealthy food) and a feeling of a lack of control over their eating (opposite of anorexia), feel terrible, purge, feel better (relief, satisfaction), reinforcement

psychological cycle of bulimia

Vermont Mandated Reporter's guide

reduces stigma so that people will be more comfortable calling CPS, will not be sued, once a report is done they open an assessment or investigation, assessment is preferred, investigation is for more serious cases, unless there is an eminent safety concern or immediate danger = assessment: a social worker goes to the school and meet with the family, see if services can be provided to ensure it doesn't happen again, follow up to make sure complying to services and other reports are made, limited resources and trying to allocate those resources as well as possible, even a substantial report of physical abuse does not get highest priority, dont investigate every report of physical abuse and neglect because there are too many of them

set context to get valid info, tell them its okay to say you dont know, truth vs lie, child assumes if an adult asks them something they want a specific answer, non-suggestive open-ended questions, use variations of please tell me more/keep talking, hard because children cannot always recall where they learned something and often not able to tell how they came to certain knowledge, children can be suggestive to past interviewing or integrating information from old memories e.g. old suggestive things from past interviews integrated into their memories, want to believe victims but children are highly suggestible and not always reliable, and unintentional suggestiveness can change their memories/answers, need to be videotaped and done in a manner that mitigates these issues, any doubt/suggestibility is something a defense attorney can use to get the case dismissed, concerned equally with false accusations and accurate justice Jeopardy in the courtroom: want them to come up with their own names for their body parts, well-intentioned interviewer trying to make child comfortable, challengable in court, because the stakes are so high need to be EXTREMELY cautious of the way interviews are conducted, miami method: explaining (therapy+interview)=BAD!! gets overturned in court

research on children's suggestibility and recommendations for effective interviewing in a forensic setting

had them rate what their body size was and what is more attractive to the opposite sex, on avergae rated themselves around a 4, but said they wanted to have a 3, and that the opposite sex/ other women wanted a 2 when men really wanted a 3.5, college women over estimate the degree to which their peers want/buy into this thin-ideal, self-fulfilling prophecy puts at risk people in a place where exposure to mass-media of thin ideal = problem!

research on normative undergraduate samples and their perceptions of self/ideal body image

hard to do on human models, mice and learned helplessness: mice joined at the tail, one can control shock and the other cannot, activation in the mPFC inhibits amygdala response if stressor is controllable, ambiguous levels of controllability to stress: need to map animal models to human work, get control over aspects of stressor they can get control over stress.

resilience studies

cumulative risk models

risk factors not equally distributed across the population, need to know what risk factors and how many, number of different factors not just 1,

eating attitudes test

screening assessment, disordered eating embedded in cultural norms, sum up totals, get a range, entry point into assessment

friendship as a protective factor (For some maltreated children, having a close friend was related to improvements in self-esteem over time), dont need to be the most popular kid to get a buffering effect, 1 close friend is enough to buffer these effects -less satisfaction with peers, more likely to be rated as less popular, cascade of problems, less skilled at making friends, quick rejection, }Physical abuse in particular related to lower self-concept and more likely to be rated as unpopular, Association between chronicity of abuse and peer rejection appeared to be mainly related to aggressive behavior

social effects of maltreatment

encoding of cues --> interpretation of cues --> clarification of goals --> response access --> response decision --> behavioral enactment

social information processing (SIP) model steps

destabilizing factors

stage 1 (reduced tolerance for stress and disinhibition of aggression): poor child-rearing preparation, low sense of control and predictability, stressful life events, stage 2 (Poor management of acute crises and provocation): conditioned emotional arousal to child behavior, multiple sources of anger and aggression, belief that child's behavior is threatening or harmful to parent stage 3 (Habitual patterns of arousal and aggression with family members): child habituated to physical punishment, parent is reinforced for using strict control techniques, child increases problem behavior

Restricting subtype: no binges / purges Binge-eating/purging subtype: as defined, some sort of compensatory purging

subtypes of Anorexia nervosa

*

subtypes of bulimia nervosa

treatment not unlike SUD treatment, repeat times getting help, relapse prevention, plan for when something triggers them, most ambivalent about treatment, often get reinforced by peers (e.g. omg you look so good!), need to address this and establish trust up front or else it wont work, walk a delicate balance dealing with parents and not blaming them Inpatient vs. outpatient decision Depends on weight, overall health status (needs to be a fairly immense health risk of highly problematic. inpatient: usually brief, couple days to weeks) Initial goal: restore weight, give psychological support Nutritional rehab Identify / understand dysfunctional attitudes (CBT) Address comorbid psychopathology p Often includes family therapy and CBT

treatment for anorexia

treatment not unlike SUD treatment, repeat times getting help, relapse prevention, plan for when something triggers them, most ambivalent about treatment, often get reinforced by peers (e.g. omg you look so good!), need to address this and establish trust up front or else it wont work, walk a delicate balance dealing with parents and not blaming them Identification of "triggers" for purging Psychoeduation on harmful consequences of vomiting Normalize eating pattern / "break cycle" of binge-purge (CBT, charts) Sometimes includes antidepressant medication "Relapse prevention": strategies for dealing with stress

treatment for bulimia

Maudsley method

treatment of adolescent anorexia, Family-oriented Contrary to most prior interventions (work with the family to regain control over child's eating, family goes to clinic and has dinners there, reassert authority as parents, disrupt the family dynamic where parent has given up, if get weight gain gradually transfer weight control back to the child, once back in a healthy relationship with food can focus on other psychological problems) Focus on separating disorder from the individual, not assigning blame to any party (dont care how we got here but how to fix for the future,) "Agnostic" as to cause Stages Weight gain / "re-feeding" (parents in control, set consequences; sometimes involves family meals in clinic) Gradual transfer of weight control back to child (once maintaining 95% target weight) Individual therapy focused on issues of adolescence, and/or family therapy

Neglect: 59% Physical abuse: 19% Sexual abuse: 10% Emotional abuse: 7% Other: 9.5%

trends in maltreatment (demographic, prevalence by type)

Fixed markers - does not change, Variable markers - SES, correlated with the negative outcome Causal risk factors - demonstrate that changes in the risk factor actually produce the negative outsome

types of risk factors

a broader context, destabilizing factors, something that arises over time with parents not confident in parenting, not good sense of control over life, and not well equip to be a parent, lack of compensatory factors and then triggering events and parent looses control, can get entrenched - coercive cycles, mainly uses intimidation and force, works, in the short term, child learns this is the way to behave, child behavior gets worse (reinforces both parent and child), lack of self-policing (lack of community support), over determination of physical abuse (5+ year history of things going wrong and warning signs throughout those years, want to change dynamics of societal structures)

what causes abuse?

Parenting groups Child social-skills groups Mentoring Academic tutoring Home visits Peer pairing

what extra things did the high-risk youth group get in the FAST track study?

trauma-focused CBT (TF-CBT)

what is the following an example of?: Assisting the child in sharing a verbal, written, or artistic narrative about the trauma(s) and related experiences Encouraging gradual in vivo exposure to trauma reminders if appropriate Cognitive and affective processing of the trauma experiences (overlay more positive healthy set of conditioned responses) Education about healthy interpersonal relationships (model close relationships without abuse Parental treatment components including parenting skills Personal safety skills training Coping with future trauma reminders (relapse prevention: will be cues in the future need to talk them through and cope with these to prevent future victimization, very likely to be re-victimized as adults, predators are attuned to certain cues people who have suffered maltreatment express, makes them vulnerable, prevent them from falling back into the abuse in the future)