Psy 355 exam 3

Conduct problems- perspectives

legal: -Juvenile delinquency: children who have broken a law. - minimum age of responsibility ranges from 7-14 in most states and provinces Psychological: Conduct problems seen as falling on a continuous dimension of externalizing behavior - children at the upper extreme, 1 or more SD above the mean, are considered to have conduct problems Psychiatric: conduct problems viewed as distinct mental disorders based on DSM symptoms - In the DSM-5, disruptive behaviors are described as persistent patterns of antisocial behavior ( ODD, CD) Public health: Blends the legal, psychological, and psychiatric perspectives with public health concepts of prevention and intervention - Goal: decrease number of injuries, deaths, and personal suffering.

p-DD: Prevalence

1. Rates of p-dd are lower than MDD -approximately 1% of children and 5% of adolescents 2. most common comorbid disorder is MDD: -nearly 70% of children with Persistent Depressive Disorder may have an episode of major depression

Oppositional Defiant Disorder(ODD)

- Age-inappropriate recurrent pattern of stubborn, hostile,disobedient, and defiant behaviors -usually appears by age 8 -symptoms can be grouped into those of: 1.negative affect 2.Defiance 3. Hurtful Behaviors

Normal Anxieties

- Anxieties are common during childhood and adolescence - the most common -> separation anxiety -> test anxiety -> Excessive concern about competence -> Excessive need for reassurance -> Anxiety about harm to a parent - girls display more anxiety than boys, but symptoms are similar

Experiencing Anxiety

- Anxiety: a mood state characterized by strong negative emotion and bodily symptoms of tension in anticipation of future danger or misfortune - moderate amounts of anxiety are adaptive -excessive, uncontrollable anxiety can be debilitating - neurotic paradox: a self-defeating behavior pattern * despite knowing there is little to be afraid of, a child is terrified and does everything possible to escape/avoid the situation - fight/flight response *immediate reaction to perceived danger or threat aimed at escaping potential harm

Anxiety vs Fear & Panic

- Anxiety: future-oriented mood state, which may occur in absence of realistic danger; characterized by feelings of apprehension and lack of control over upcoming events. - Fear: Present-oriented emotional reaction to current danger, characterized by strong escape tendencies and surge in sympathetic nervous system. - panic: group of physical symptoms of fight/flight response that unexpectedly occur in the absence of obvious danger or threat

CD: Age of onset

- Children with childhood-onset CD display at least one symptom before age 10 1. more likely to be boys 2. show more aggressive symptoms 3. Account for disproportionate amount of illegal activity 4. Persist in antisocial behavior over time - children with adolescent- onset CD 1. As likely to be girls as boys 2. do not show the severity or psychopathology that characterizes early-onset group 3. Less likely to commit violent offenses or persist in their antisocial behavior over time

Cognitive and verval deficits

- IQ scores lower for children with CD 1. Greater deficit for children with childhood-onset -verbal IQ<performance IQ -Deficits in executive functioning 1. may be due to co-occurring ADHD 2. Types of executive functioning deficits may differ for children with ODD and CD and those with ADHD

Normal Fears and Anxieties

- Moderate fear and anxiety are adaptive - To determine if fears are normal must consider: -> developmental period -> effect on the child and duration - the number and types of fears change over time, with a general age-related decline in numbers

Prevalence

- ODD more prevalent than CD during childhood; by adolescence, prevalence is equal -lifetime prevalence rates 1. 12% for ODD ( 13% males, 11% for females) 2. 8% for CD (9% for males,6% for females) -prevalence estimates for CD and ODD across culture are similar

Antisocial Personality Disorder (ADP) and Psychopathic Features

- Pervasive pattern of disregard for and violation of the rights of others 1. As many as 40% of children with CD later develop APD 2. Adolescents with APD may display psychopathic features: pattern of callous, manipulative,deceitful, remorseless behavior - subgroup of children with CD are at risk for extreme antisocial and aggressive acts and for poor long-term outcomes 1. Display callous and unemotional (CU) interpersonal style

SAD:Prevalence and Comorbidity

- SAD is one of the two most common childhood anxiety disorders -occurs in 4-10% of children -more prevalent in girls - comorbid with other anxiety disorders

genetic influences: adoption and twin studies

- adoption and twin studies: 50% or more of variance in antisocial behavior is hereditary 1. parents pass on general liability for externalizing disorders to their children 2. higher genetic contribution for children with LCP versus AL pattern for those with callous-unemotional traits - adoption and twin studies suggest contribution of genetic and environmental factors

SAD: onset, course, and outcome

- earliest reported age of onset of anxiety disorders(7-8 years of age) -progresses from mild to severe -associated with major stress - persists into adulthood for more than 1/3 of affected children and adolescents - as adults, more likely to experience: -> relationship difficulties -> other anxiety disorders and mental health problems -> functional impairment in social and personal life

selective mutism

- failure to talk in specific social situations, even though they may speak loudly and frequently at home or other settings - estimate to occur in 0.7% of children -average age of onset is 3-4 years -may be an extreme type of social phobia, but there are difference between the two disorders

cognitive

- focus on relationship between negative thinking and mood -emphasize depressogenic cognitions -beck: depressed individuals make negative interpretations about life events because they use biased and negative beliefs as interpretive filters for understanding these events

School and learning Problems

- high rates of: 1. underachievement 2.grade retention 3.special education placement 4. Dropout 5. Suspension and expulsion - early language deficits may lead to reading and communication difficulties which may increase conduct problems in school -relationship between conduct problems and underachievement is firmly established by adolescence

Social Anxiety Disorder: Prevalence,comorbidity, and course

- lifetime prevalence of 6-12% of children -more common in girls -2/3 also have another anxiety disorder, most commonly GAD -20% also suffer from major depression -most common age of onset is early to mid-adolescence, and is rare under age 10 - prevalence increase with age and may be predicted by early rejection by peers

self-esteem deficits

- low self-esteem is NOT the primary cause of conduct problems 1. problems are related to inflated, unstable, and/or tentative view of self - youths with conduct problems may experience high self-esteem that over time permits them to rationalize their antisocial conduct

Conduct Disorder(CD)

- repetitive, persistent pattern of severe aggressive and antisocial acts that involve inflicting pain on others or interfering with rights of others through physical and verbal aggression, stealing, or acts of vandalism -3 or more behaviors for a period of 12 months: 1.aggression to people and animals 2. destruction of property 3. Deceitfulness or theft 4. serious violations of rules

DSM-5 classification of Anxiety Disorders

- separation Anxiety Disorder ( SAD) - Specific Phobia -Social Anxiety Disorder(SOC) -Selective Mutism - Panic Disorder (PD) -Agoraphobia - Generalized Anxiety Disorder ( GAD)

Panic attack

- sudden, overwhelming period of intense fear of discomfort accompanied by four or more physical and cognitive symptoms characteristic of the fight/flight response - rare in young children, common in adolescents -related to puberal development, not age

Family Problems

- the strongest and most consistent correlates of conduct problems 1. General family disturbances 2. Specific disturbances in parenting practices and family functioning 3. High levels of conflict are common in the family, especially between siblings. 4. lack of family cohesion and emotional support 5. deficient parenting practices 6. parental social-cognitive deficits

Peer Problems

- young children with conduct problems display 1. poor social skills 2. verbal and physical aggression toward peers - often rejected by peers, although some are popular 1. underestimate own aggression and its negative impact, and overestimate others' aggression toward them 2. Reactive-aggressive: children display hostile attributional bias: attribute negative intent to others 3. Proactive-aggressive: children view their aggressive actions as positive.

Panic Disorder (PD)

1. recurrent unexpected panic attacks 2. at least one attack followed by at least one month of: - persistent concern about having another attack or constant worry about the consequences -significant change in behavior related to the attacks( anticipatory anxiety)

Causes Psychological dimension

-Hilda Bruch: related to struggle for autonomy, competence, control, and self-respect -Arthur Crisp: phobic avoidance disorder -Characterized as being obsessive and rigid, showing emotional restraint, poor adaptability to change -Bulimia: mood swings, poor impulse control, obsessive-compulsive behaviors -Almost 90% of persons with eating disorders have co-occurring disorders -Discrepancy between one's actual self and one's ideal self increases the likelihood of eating problems, especially among women

Causes

1.Heritability accounts for a substantial portion of the variance in obesity 2.Individual and family-related factors (ex. dietary and lifestyle preferences) -Parents determine food availability, and they model an approach to exercise and diet -Family disorganization: poor communication, lack of perceived family support, and sexual and physical abuse

School Reluctance and refusal

-School refusal behavior: - >refusal to attend classes or difficulty remaining in school for an entire day - equally common in boys and girls -occurs most often between ages 5-11 -fear of school may be fear of leaving parents(separation anxiety), but can occur for many other reasons -serious long-term consequences if it remains untreated

Causes Family influences:

-Teen's eating disorder may be functional in that it directs attention away from basic family conflicts -Family processes may contribute to an overemphasis on weight and dietary control -Child sexual abuse could be a risk factor for eating disorders, especially bulimia

Child and Family Influences

1.No child characteristic has been linked to the risk of maltreatment, once environmental and adult factors are controlled for 2.Coercive family interactions 3.Family conflict and marital violence are linked to child maltreatment

Associated Characteristics

-cognitive and verbal deficits -school and learning problems -self-esteem deficits -peer problems -family problems -health-related problems

behavioral

-emphasize the importance of learning , environmental and consequences, and skills and deficits during the onset and maintenance of depression -depression is related to a lack of response-contingent positive reinforcement

interrelated Anxiety Response Systems

-physical system: the brain sends messages to the sympathetic nervous system, which produces the fight/flight response and activates important chemicals -cognitive system: activation often leads to subjective feelings of apprehension, nervousness, difficulty concentrating, and panic behavioral system: aggression and a desire to escape the threading situation * avoidance perpetuates anxiety

Health- Related Problems

-rates of premature death, before age 30, are 3 to 4 times higher in boys with conduct problems -early onset and persistence of sexual activity and sexual risk-taking by age 21 - substance use disorder and adolescent antisocial behavior are strongly associated - increased risk for substance abuse as adult

Depression in Young People

1. 5% of children and 10-20% of adolescents experience significant depression at some time 2. 90% show significant impairment in daily functions 3. Depression in young people is a serious concern -long-lasting emotional suffering -problems in everyday living -heightened risk for suicide, substance abuse,bipolar disorder, health issues

onset, course, and outcome

1. 60% of patients with BP have first episode prior to age 19. 2. peak age of onset between 15 and 19 years of age 3. risk factors for mania: - major depressive episode -family history of mood disorders, especially BP 4. Adolescents with mania typically experience: - psychotic symptoms -unstable moods with mixed manic and depressive features -severe deterioration in behavior 5. early onset and course is chronic and resistant to treatment, with poor long-term prognosis

Social Anxiety Disorder( Social Phobia)

1. A marked, persistent fear of social or performance requirements that expose the child to scrutiny and possible embarrassment - most common fear is doing something in front of others -more likely than other children to be highly emotional, socially fearful, and inhibited, sad, and lonely - May experience physical symptoms - recent research suggests that interaction- and performance-related social fear differ in many aspects

Depression

1. A pervasive unhappy mood disorder,more severe than the occasional blues or mood swings everyone experiences 2. children who are depressed: -cannot shake their sadness -difficulties in their daily routines -social relationship affected -school performance deteriorates 3. over 3 million children and teens in U.S suffer from depression yearly

Context of Conduct Problems

1. Antisocial behaviors appear and decline during normal development - vary in severity - some antisocial behaviors decrease with age, whereas others increase with age and opportunity - some antisocial behaviors decrease with age, whereas others increase with age and opportunity - more common in boys in childhood, but the difference narrows in adolescence 2. early, persistent, and extreme pattern of antisocial behavior occurs in about 5% of children

MDD: Comorbidity

1. As many as 90% of young people with depression have one or more other disorders;50% have two or more 2. most common comorbid disorders: -anxiety disorders(especially GAD) -specific phobias - separation anxiety disorders -persistent depressive disorders -conduct problems -ADHD -substance-use disorder

prevention

1. CBT and interpersonal psychotherapy - most effective at lowering risk for depression and for preventing recurrences 2. school- based initiatives - comprehensive program to inhale protective factors in the environment and to develop young people's individual resiliency skills 3. large-scale prevention efforts( teen screen( - early detection of high school students at risk for depression and suicide 4. family group cognitive-behavorial interventions for children's of parents with a history of MDD.

temperament

1. Children differ in reactions to novel or unexpected events. 2. Behavioral inhibition (BI) -A low threshold for novel and unexpected stimuli=greater risk for anxiety disorders 4.Development of anxiety disorders in BI children depends on: -Gender -Exposure to early maternal stress -Parental response

Categories of Conduct Problems

1. Covert-Property Destructive 2.Aggression 3. Status Offenses 4. Oppositional

Problem-solving skills training (PSST)

1. Focuses on cognitive deficiencies and distortions in interpersonal situations 2. five problem-solving steps to identify thoughts, feelings, and behaviors in problem social situations 3. therapist uses instruction, practice, and feedback 4. children learn to: - appraise the situation -identify self-statement and reactions -alter their attributions about others' motivations -learn to be more sensitive to others

Neurobiological Factors

1. Overactive behavioral activation system (BAS) and underachieve behavioral inhibition system (BIS) 2. variations in stress-regulating mechanisms( i.e. ANS) 3. Structural and functional brain abnormalities - amygdala 3. Early findings suggests 3 neural systems: - subcortical neural systems: leading to aggressive behavior -prefrontal cortex: decision-making circuits and socioemotional information processing circuits that assess social cues and evaluate consequences of aggression. -frontoparietal regions: involved in regulating emotions and impulsive urges

family factors

1. Parenting practices 2. Characteristics of parents of anxious children -Overinvolved -Intrusive or limiting child's independence -Critical and less positive interactions with their children 4.Prolonged exposure to high doses of family dysfunction 5. Lower parental expectations for children's coping abilities 6.Insecure early attachments (particularly ambivalent attachment) may be a nonspecific factor

Medications

1. SSRIs(Prozac) are the most commonly prescribed medication for treating childhood depression -side effects include suicidal thoughts and self-harm as well as a lack of information about long-term effects on the developing brain 2. up to 60% of depressed youngsters respond to placebo; 15-30% respond to brief treatment - in milder cases education, support, and case management related to school and family stressors may be effective

Cognitive-behavior therapy (CBT)

1. Teaches children: -To understand how thinking contributes to anxiety -How to modify their maladaptive thoughts to decrease symptoms 2.Coping Cat: emphasizes learning processes and the influence of contingencies and models, as well as role of information processing 3. Skills training and exposure combat problematic thinking Child-focused treatments may have spillover effects into the family Therapy in family context may result in more dramatic and lasting effects than only focusing on the child. Medications Medications

Parent Management Training (PMT)

1. Teaches parents to change child's behavior in the home 2. Focuses on - improving parent-child interaction -promoting positive behavior -decreasing antisocial behavior 3. short-term effectiveness, especially with children under 12 4. Treatment sessions cover use of commands, rules, praise, rewards,mild punishment, negotiation,and contingency contracting

neurobiological influences

1. abnormalities in brain structures - amygdala, cingulate,prefrontal cortex, hippocampus 2. neuroendocrine system 3.cortical thinning in right hemisphere 4.sleep abnormalities 5.neurotransmitters - serotonin,dopamine, and norepinephrine 6.heightened sensitivity to stress

cultural factors

1. across cultures, socialization of children for aggression is one of the strongest predictors of aggressive acts 2. rate of antisocial behavior vary widely across and within cultures 3. antisocial behavior is associated with minority status in the U.S. but this is likely due to low SES

specific phobia

1. age-inappropriate persistent, irrational, or exaggerated fear that leads to avoidance of the feared object or event and causes impairment in normal routine - duration: 6 months or longer -extreme and disabling fear of objects or situation that in reality pose little or no danger or threat - avoidance of the object/ situation -beliefs persist despite evidence no danger exists -if feared object/situation is encountered often it can become a serious problem 2. about 20% of children at some point in their lives experience specific phobia 3. Most common co-occurring disorder is another anxiety disorder 4. average age of onset: 7-9 years of age 5. peaks between 10-13 years of age

genetic influences

1. antisocial " propensity" or "personality" 2. may increase likelihood for child's exposure to environmental risk factors 3. Genotype and neurobiology may moderate susceptibility to environmental insults 4. possible gene-environment interactions - low-active MAIA genotype in maltreated children

Social- cognitive Factors

1. antisocial behavior linked to following: - immature forms of thinking -cognitive deficiencies -cognitive distortions -deficits in facial expression recognition and eye contact 2. Dodge and Petti: - comprehensive social-cognitive framework model to account for aggressive and antisocial behavior in children

social and emotional deficits

1. anxious children display: - low social performance -high social anxiety 2. others are likely to view them as: - anxious -socially maladjusted 3. view themselves as: - shy and socially withdrawn -experiencing low self-esteem -lonely -having difficulty initiating and maintaining friendships

GAD: onset, course, and outcome

1. average age of onset is easy adolescence 2. older children - have more symptoms - report higher levels of anxiety and depression 3. these symptoms may diminish with age

OCD: onset, course, and outcome

1. average age of onset: 9-12 years with peaks in early childhood and late adolescence 2. chronic disorder: as many as 2/3 continue to have OCD 2-14 years after initial diagnosis

Psychosocial interventions

1. behavior therapy - increase pleasurable activities and events -provide children with the skills necessary to obtain more reinforcements( social skills training) 2. cognitive therapy - learn to identify, challenge, and modify negative thought processes. 3. cognitive- behavior therapy: - more adaptive thoughts are hypothesized to lead to more adaptive behaviors

MDD: Prevalence

1. between 2% and 8% of children ages 4-8 2. rare among preschool and school-age children(1-3%), increases by adolescence 3. the modest increase from preschool to elementary school may reflect: - growing self-awareness and cognitive capacity -verbal ability to report symptoms -increased performance and social pressures 4. the sharp increase in adolescence may results from: -biological maturation at puberty interacting with developmental changes

bipolar disorder diagnoses

1. bipolar I disorder - requires evidence for a manic episode and one or more major depressive episodes 2. bipolar II disorder - requires a hypomanic episode in combination with one or more major depressive episodes. 3. cyclothymic Disorder - 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 disorders 4. other specified bipolar disorders - display characteristic symptoms of BP that cause significant functional impairment but do not meet criteria for any of the others types of bipolar disorders

prevalence

1. bipolar II and cyclothymic disorders are most likely 2. "rapid cycling" also more common 3. extremely rare in young children, but increase after puberty 4. affects males and females equally 5. boys show more manic mood and girls more depressed moods

Disruptive Mood Dysregulation disorde (DMDD)

1. chronic, severe, persistent irritability -frequent verbal or physical temper outburst -chronic, persistently irritable or angry mood 2. Added to DSM-5 due to: - concerns about increasing rate of bipolar disorder diagnoses in young children - growing use of medications to threat children -new disorders with little research

Treatment for depression

1. cognitive- behavioral therapy (CBT) - has shown the most success in treating children and adolescents with depression 2. interpersonal psychotherapy for adolescents depression (IPT-A) - focuses on improving interpersonal communication 3. psychopharmacological treatments: - with the exception of SSRIs, which have problematic side effects, medications have been less effective than CBT AND IPT-A

Persistent Depressive Disorder

1. criteria -symptoms of depressed mood that occur on most days, and persist for at least on year -display at least two somatic or cognitive symptoms 2. less severe symptoms,but more chronic than MDD 3 characterized by poor emotion regulation

stressful life events

1. depression is associated with severe and nonsevere stressful life events 2. triggers for depression may involve: -interpersonal stress and actual or perceived personal losses - life changes( moving to a new neighborhood) -violent family environment -Daily hassles and other nonsevere stressful life events 3. although sadness and depression following these events are common, they are not inevitable

GAD: prevalence and comorbidity

1. discrepancy of prevalence of GAD in children and adolescents 2. Equally common in boys and girls with slightly higher prevalence in older adolescents females 3. high rates of other anxiety disorders and depression

cognitive disturbances

1. disturbance in how information is perceived and processed 2. intelligence and academic achievement: -no correlation between anxiety and IQ -deficits are seen in memory, attention, and speech or language 3. selective attention to potentially treating or dangerous information - anxious vigilance or hyper vigilance permits the child to avoid potentially threatening events 4. cognitive errors and biases - perceptions of threats activate danger-confirming thoughts - see themselves as having less control over anxiety-related events than other children

emotion regulation

1. emotion regulation: processes by which emotional arousal is redirected,controlled, or modified to facilitate adaptive functioning, and to the balance maintained among positive, negative, and neutral mood states. - strategies for self-regulation are important for overcoming, maintaining, or preventing negative emotional states -use avoidance or negative behavior to regulate distress

generalized anxiety disorder

1. excessive,uncontrollable anxiety and worry about many events and activities on most days 2. episodic or continuous 3. worry excessively about minor everyday occurrences 4. not specific but widespread 5. accompanied by at least one somatic symptom(e.g headaches, stomach aches, muscle tension, and trembling) 6. must occur a majority of the days in 6 month period

other family problems

1. family instability and stress: - high family stress may be both a cause and an outcome of child's antisocial behavior - unemployment, low SES, multiple family transitions, instability, and disruptions in parenting practices - poverty is one of the strongest predictors of CD 2. Parental criminality and psychopathology: - aggressive and antisocial tendencies run in families within and across generations

Agoraphobia

1. fear of being alone in and avoiding certain places or situations 2. fear of having a panic attack in situation where escape would be difficult or help is unavailable 3. Distinct disorder, separate from panic attacks and panic disorder,

Bipolar Disorders

1. features: a striking period of unusually and persistently elevated, expansive, or irritable mood, alternating with or accompanied boy one or more major depressive episodes -elation and euphoria 2. controversy: identification of BP in young people - often show extreme variability and overlap of symptoms with other children disorders. - how BP is labeled has important implications for treatment. 3. young people with BP display: - significant impairment in functioning, including previous hospitalization -MDD -medication treatment -co-occurring disruptive behavior, anxiety disorders -history of psychotic symptoms and suicidal ideation/attempts. 4. symptoms include: - restlessness -agitation - sleeplessness - pressured speech -flight of ideas -racing thoughts -sexual disinhibition -surges of energy -expansive grandiose beliefs

MDD: Gender

1. females are: - two times more likely to suffer from depression in adolescence - more susceptible to mild mood disorders -more likely to experience recurrent episodes 2. physical, psychological, and social changes are related to the emergence of sex difference in adolescence 3. sex differences in depression partly rooted in biological differences in brain processes that regulate emotions

Causes of Conduct problems

1. genetic influences 2. prenatal factors and birth complications 3. neurobiological factors 4. social-cognitive factors 5. family factors 6. societal factors - media 7. cultural

genetic and family risk

1. heritability estimates ranging from 30-40% 2. children of parents with depression have about three times the risk of having depression 3. a vulnerability to depression and anxiety is likely inherited

comobidity

1. high rates of co-occuring disorders are extremely common: - most typical are separation anxiety disorders generalized anxiety disorders, ADHD, and oppositional and conduct disorders 2. substance use disorders 3. suicidal thoughts and ideation

cognitive theory of depression

1. hopelessness theory 2. negative attributional style 3. beck's model of depression states depressed individual show cognitive problems in 3 areas: - information processing biases -negative outlook -negative cognitive schemata

Obsessive-compulsive disorder

1. recurrent,time-consuming, disturbing obsessions and compulsions performed to relieve anxiety 2. obsessions: persistent and intrusive thoughts, ideas, impulses, or images 3. compulsions: repetitive, purposeful, and intentional behaviors or mental acts 4. OCD is extremely resistant to reason 5. rituals fail to provide long-term relief from anxiety 6. often leads to severe disruptions in normal activities, health, social and family relations, and school functioning

associated characteristic of depressive disordes

1. intellectual academic functioning: - difficulty concentrating, loss of interest, and slowness of thought and movement are likely to: * results in lower scores on tests * poor teacher ratings *lower levels of grade attainment 2. interference with academic performance, but not necessarily related to intellectual ability * may have problems on tasks requiring attention, coordination, and speed 3. cognitive biases and distortions: - selective attentional biases -feelings of worthlessness, negative beliefs,attributions of failure, self-critical and automatic thoughts - depressive ruminative style; pessimistic outlook - negative thinking and faulty conclusion generalize across situation, hopelessness, and suicidal ideation 4. negative self-esteem: - low or unstable self-esteem play important role -may be related to negative body image 5. Social and peer problems: - few close friendships, feelings of loneliness, and isolation - social withdrawal and ineffective styles of coping in social situations -co-rumination is a strong risk factors for the onset of depression in adolescent females 6. family problems: - less supportive and more conflicted relationships with parents and siblings - feel socially isolated from families and prefer to be alone 7. depression and suicide: -profound feelings of hopelessness,helplessness, and despair may lead to suicide attempt - as many as 1/3 who think about suicide,attempt it -strongest risk factors for suicidal behavior worldwide are having a mood disorder and being a young female -Ages 13 and 14 are peak periods for first suicide attempt

Multi systemic Therapy (MST)

1. intensive family-and community- based approach for adolescents with severe conduct problems 2. antisocial behavior results from/is maintained by transactions wishing or between any of the systems 3. attempts to empower caregivers to improve youths and family functioning 4. effective in reducing long-term rates of criminal behavior for periods as long as five years

OCD: prevalence and comorbidity

1. lifetime prevalence in children and adolescents is 1-2.5% 2. twice as common in boys( clinic based) 3. comorbidities: -other anxiety disorders( most common) -depressive disorders -disruptive behavior disorders

Prenatal Factors and birth complications

1. low birth weight 2. malnutrition during pregnancy 3. lead poisoning 4. mother's prenatal use of nicotine, marijuana, and other substances. 5. Prenatal maternal alcohol use 6. correlational evidence only. No link for direct biological causation

Mania

1. manic episode - hallmark feature of BP - youngsters with mania may present with atypical symptoms: changes in mood , psychomotor agitation, mental excitation, volatile and erratic, irritability, belligerence -classic symptoms for children with mania include pressured speech, racing thoughts, flight of ideas 2. hypomanic episode - resembles manic episode but less intense

Overview of Mood Disorders

1. mood disorders(affective disorder): - disturbance in mood -suffer from extreme, persistent, or poorly regulated emotional states 2. DSM-5 divides mood disorders into two general categories -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)

p-dd: onset, course, and outcome

1. most common age of onset 11-12 years 2. may be a precursor to MDD 3. childhood-onset has a prolonged duration, with average episode length of 2 to 5 years 4. Most recover, but are at high risk for developing other disorders,especially MDD, anxiety disorders, and conduct disorder - increase risk for subsequent development of bipolar disorder and substance use disorders

Clinical Symptoms: Major Depressive Disorder

1. must have at least 5 symptoms for at least 2 weeks: - depressed or irritable mood -loss of interest or pleasure -weight changes -sleep problems -motor agitation or retardation - fatigue or loss of energy -feeling worthless or guilty -poor concentration -thoughts of death or suicide 2. symptoms must cause significant impairment

societal Factors

1. neighborhood and school - antisocial behavior in youth is more common in neighborhoods with criminal subcultures 2. media - correlation between media violence and antisocial behavior

causes

1. one of the most heritable forms of mental disorders 2. results of a genetic vulnerability in combination with environmental factors( life stress, family disturbances) 3. multiple genes 4. abnormalities in areas of the brain related to emotion regulation: - Amygdala, hippocampus, basal ganglia

MDD: onset, course, and outcome

1. onset may be gradual or sudden 2. age of onset usually between 13-15 years 3. average episode lasts 8 months 4. most children eventually recover for initial episode, but the disorder does not go away -chance of recurrence:25% wishing 1 year, 40% within 2 years and 70% within 5 years -about one-third develop bipolar disorders within 5 years after onset of depression(bipolar switch) 5.overall outcome is not optimistic: -children often continue to experience adjustment and health problems and chronic stress

PD: prevalence an comorbidity

1. panic attacks are common (16% of teens) 2. panic disorde and agoraphobia is less common (about 2.5% of teens) 3. panic attacks are more common in adolescent females than males 4. comorbidity: adolescents with PD most commonly have another anxiety disorder or depression 4. age of onset for first panic attack:15-19 years

Major Depressive Disorder(MDD)

1. presence of at least 5 clinical symptoms 2. symptoms must represent change from previous functioning 3. diagnosis in children: - same criteria for school-age children and adolescents -depression is easily overlooked because other behaviors attract more attention -some features(e.g. irritable mood) are more common in children and adolescents than in adults 4. severity ratings: Mild,moderate,or severe

Theories of depression

1. psychodynamic 2.attachment 3.behavioral 4.cognitive 5.self-control 6.interpersonal 7.socio-environment 8.neurobiological

Preventive interventions

1. recognize that intense home- and school- based interventions help overcome factors 2. main assumptions: - conduct problems can be treated more easily and effectively in younger than older children -counteractinb risk factors/strengthening protective factors at young age limits/ prevents escalation of problem behaviors -reduces costs to educational, criminal justice, health, and mental health systems

physical symptoms

1. somatic complaints -stomachaches or headaches 2. more frequent in adolescents than in younger children 3. 90% have sleep-related problems - nocturnal panic, insomnia, nightmares

treatment

1. there is no cure of BP 2. able to stabilize mood and allow for management and control of symptoms 3. multimodal plan includes: - close monitoring of symptoms -education of the patient and the family about the illness -matching treatments to individuals -medication,usually lithium - psychotherapeutic interventions to address symptoms and related psychosocial impairments

Paradoxical Dilemmas

1.Abused or neglected children face paradoxical dilemmas: -The victim wants to stop the violence but also longs to belong to the family in which they are being abused -Affection and attention may coexist with violence and abuse -Intensity of violence tends to increase over time, but in some cases, physical violence may decrease or stop

Characteristics of Children who Suffer Maltreatment

1.Age: -Younger children more at risk for abuse and neglect -Over 12 years of age, at greater risk of sexual abuse -Except for sexual abuse, victimization rate is inversely related to the child's age 2.Sex: -Boys and girls are victims of maltreatment almost equally -Exception, 80% of sexual abuse victims are female -Boys are more likely to be sexually abused by male nonfamily members -Girls are more likely to be sexually abused by male family members

SUD: Prevalence and Course

1.Alcohol is the most prevalent substance used and abused by adolescents 2.Adolescent use declining in: -Cigarette smoking -Opiates, cocaine, and crack -Hallucinogens and inhalants 3.Marijuana use increasing 4.Estimate: 12% of American adolescents meet criteria for substance abuse or dependence 5.Age of onset: -Some amount of substance use during adolescence is normative behavior -Critical risk factor is age of first use -Alcohol use before age 14 is a strong predictor of subsequent alcohol abuse or dependence 6.Sex and ethnicity: -Increased substance use among girls -Gap between African American and Caucasian youth have narrowed 7.Course: -Rates typically peak around late adolescence then decline during young adulthood -Early onset of high-risk behaviors increases likelihood of SUD -Alcohol use influences involvement in other high-risk behaviors 2.Associated characteristics: -Using more than one drug simultaneously -Poor academic achievement and higher rates of academic failure -Higher rates of delinquency -More parental conflict

Obesity

1.Approximately 1 in 6 children and adolescents (aged 2-19) in North America are obese 2.Childhood obesity: a chronic medical condition characterized by excessive body fat -BMI above the 95th percentile -Severely stigmatized -Carries many social and health hazards -Significantly affects children's psychological and physical development

Treatment for Dyssomnias

1.Behavioral interventions: -Teach parents to attend to child's need for comfort and reassurance -Extinction -Good sleep hygiene -Use positive reinforcement for maintenance 2.Goals of behavioral intervention: -Eliminate sleep deprivation -Restore a more normal sleep and wake routine

Enuresis: Causes and Treatment

1.Causes include deficiency of antidiuretic hormone (ADH), immature signaling mechanism, and genetics 2.Treatments: -Bed-wetting alarms: based on classical conditioning -Dry-bed training: based on operant conditioning -Medications: desmopressin (synthetic ADH); 3.Psychological interventions (especially urine alarm) are more effective than medications or waiting for the child to grow out of the problem

Encopresis: Causes and Treatment

1.Causes include: -Avoiding, suppressing, and not recognizing signs when it is time for a bowel movement -Abnormal defecation dynamics that, combined with avoidance, increases risk for chronic constipation and encopresis develops 2.Treatment includes: -Medical interventions (fiber, laxatives) -Behavioral interventions to establish healthy elimination patterns

Anorexia Nervosa

1.Characterized by: -Refusal to maintain minimally normal body weight -Intense fear of gaining weight -Significant disturbance in perception and experiences of body size 2.Notable features: Denial of thinness 3.DSM-5 subtypes: -Restricting type: individual loses weight through diet, fasting, or excessive exercise -Binge-eating/purging type: individual regularly engages in episodes of binge eating or purging, or both

Child Maltreatment: The Numbers

1.Child maltreatment: four primary acts including physical abuse, neglect, sexual abuse, and emotional abuse 2.In North America: -1 in 10 children experience some form of sexual victimization by an adult or peer -1 in 10 receives harsh physical punishment by a parent or other caregiver that puts them at risk of injury -Each day more than 5 children die at the hands of their parents or caregivers

Family interventions

1.Child-focused treatments may have spillover effects into the family 2.Therapy in family context may result in more dramatic and lasting effects than only focusing on the child.

Family Structure and Maltreatment

1.Children from single-parent homes with a live-in partner and large families are at highest risk 2.80% of victims abused by one or both parents 3.Sexual abuse: -Nearly 50% abused by persons other than parents/parent figure -Males are offenders 90% time 4.Mother is perpetrator of neglect 90% of time 5.Most common perpetrator for child maltreatment: female parent acting alone, under 30 years of age

Results of Successful Interventions

1.Children understand: -That what happened to them was abuse -That it was wrong -That it may have caused them some temporary problems 2.Emotional and behavioral problems arising from the abuse should subside 3.Supportive relationships are in place for the children 4.Children regain their normal rate of development

Treatment: Exposure Based Therapy

1.Cognitive behavior therapy involving imagined or real-life exposure to feared stimuli has been effective for children experiencing PTSD -Early exposure intervention: brief and based on belief that children need information and support -Trauma-focused cognitive behavioral therapy: psychosocial treatment model that incorporates elements of cognitive-behavioral, attachment, humanistic, empowerment, and family therapy models

Exploitation

1.Commercial or sexual exploitation 2.Significant form of trauma for children and adolescents worldwide 3.As many as 10 million children may be victims of child prostitution, the sex industry, sex tourism, and pornography

Developmental Risk Factors

1.Continuum of "eating pathology" ranges from dieting to clinical syndromes across all developmental periods 2.Drive for thinness: belief that losing more weight is the answer to overcoming problems and achieving success 3.Early eating habits, attitudes, and behaviors: -.Children preoccupied with weight and dieting as young as ages 7-10 -.Constellation of physical and psychological factors linked to early eating problems and distorted beliefs 4.Transition into adolescence: -Anorexia and bulimia typically occur during adolescence -Affects girls more than boys -Contradictory social messages implying that women must be successful in traditional feminine and masculine roles -Changes encourage smoking and other substance use to prevent impulse to binge eat and consequences of weight gain 5.Dieting and weight concerns: -Restrictive dieting is common in North America -Chronic dieting: continuously remain on a diet or diet sporadically more than 10 times during a year -Dieting may lead to a vicious cycle of weight loss and weight gain, overeating, and the "false hope syndrome," as well as binge eating and subsequent purging -Many young people diet, but only a small minority develop eating disorders

SUD: Diagnostic Criteria

1.Core feature: Problematic pattern of substance use leading to clinically significant impairment or distress. 2.Must demonstrate 2 or more significant clinical signs of distress for a period of at least 12 months -Impaired control -Social impairment -Risky use -Pharmacological criteria

Disinhibited Social Engagement Disorder (DSED)

1.DSED: pattern of overly familiar and culturally inappropriate behavior with relative strangers -Overly familiar physically or verbally -Behaviors NOT related to impulsivity -Patterns of insufficient care

Features of Sleep Disorders

1.Dyssomnias: disorders of initiating or maintaining sleep, characterized by difficulty getting enough sleep, not sleeping when one wants to, not feeling refreshed from sleep -Involve disruptions in the sleep process -Many of these problems resolve themselves as the child matures -Quite common in childhood, with the exception of narcolepsy

How Eating Patterns Develop

1.Early childhood -Problematic eating habits and picky eating are common 2.Late childhood/adolescence -Societal norms and expectations affect girls more than boys 3.Factors in development of eating patterns: -Parent-child relationship

Prevalence and Development

1.Eating disorders among young men: -More common than originally believed -Less preoccupied with food or a drive for thinness than females -Place more emphasis on being muscular 2.Sexual orientation and eating disorders: -Gay men are at greater risk for behavioral symptoms of eating disorders compared to heterosexual men -Gay men are more susceptible to media images promoting thinness -More likely to experience poor body image and body dissatisfaction

Elimination Disorders

1.Elimination problems can turn into distressing and chronic difficulties, and can affect participation in education and social activities 2.Have implications on development of self-competence and self-esteem 3.Two elimination problems occurring during childhood and adolescence: -Enuresis -Encopresis 4.Children eventually outgrow eliminating disorders

Encopresis

1.Encopresis: The passage of feces into inappropriate places -Occurs at least once per month for three months -Child must be at least 4 years old 2.Prevalence and course: -5 to 6 times more common in boys -Declines rapidly with age -Primary: child has reached age 4 without establishing fecal continence -Secondary: a period of continence was previously established -One in five children with encopresis show significant psychological problems, but the problems likely result from, rather than cause, the encopresis

Enuresis

1.Enuresis: Involuntary discharge of urine during day or night -At least twice a week for three months or accompanied by significant distress or impairment -Child at least 5 years old 2.Three subtypes: -Nocturnal only: most common; wetting occurs only during sleep at night -Diurnal only: passage of urine during waking hours -Combination of nocturnal and diurnal

Prevalence and Development

1.Ethnic and cross-cultural and socioeconomic considerations: -Anorexia occurs around the world, but it may manifest differently -Bulimia is a culture-bound syndrome arising predominately in Western regions of the world, or those exposed to Western ideals and culture -Some connection exists suggesting that body dissatisfaction is more strongly associated with SES than is ethnicity

Trauma and Stress

1.Experiences may involve actual or threatened death, injury, or treat to one's physical integrity 2.Younger children exposed to violence: -Fearful -Somatic signs of distress -Regressive behaviors 3.Older children exposed to violence: -Boys: more aggressive -Girls: more passive and withdrawn, lower self-esteem 4.Adolescents reporting levels of stress similar to adults

behavioral therapy

1.Exposure to feared stimulus while providing children with ways of coping other than escape and avoidance 2.Systematic desensitization: teaching child to relax, constructing anxiety hierarchy, presenting anxiety-provoking stimuli while child remains relaxed 3. flooding: prolonged repeated exposure 4.Response prevention: prevents child from engaging in escaping or avoidance stimuli 5.Modeling and reinforced practice; in vivo exposure works best

SUD: Treatment and Prevention

1.Family-based approaches: -Modify negative interactions between family members -Improve communication -Develop effective problem-solving skills to address areas of conflict -Multisystemic Therapy (MST) involves intensive intervention that targets family, peer, school, and community systems -Most effective approach

PTSD

1.First symptoms usually present within 3 months of trauma 2.Prevalence of symptoms is greater in children who are exposed to life-threatening events -Strongly correlated with degree of exposure 3.Nearly ½ of victims of maltreatment meet criteria for PTSD -Disruptions in their view of themselves and the world that leads to emotional and behavioral changes

Treatment

1.Focus on: -Parents' knowledge of nutrition -Increasing child's physical activity -Encourage child's eating behaviors and physical activity patterns to be more adaptive and self-managed 2.Schools role in educating children: -Nutrition -Exercise -Awareness of healthy eating attitudes and body image

gender, ethnicity, and culture

1.Higher incidence in girls than boys. 2.The experience of anxiety is pervasive across cultures 3.Ethnicity and culture may affect: -the expression -developmental course -interpretation of anxiety symptoms 4.Cultural differences in traditions, beliefs, and practices affect occurrence and perception of anxiety and related symptoms

Affect of Stress on the Child

1.Hyperresponsive: chronically aroused by a stressful environment 2.Hyporesponsive: under reacting to signs of danger or threat 3.Allostatic load: progressive "wear and tear" on biological systems due to effects of chronic stress 4.Degree of parental support and assistance a child has is main factor in how they respond to stress.

Obesity: Prevalence and Development

1.In U.S. and Canada, obesity rate nearly tripled for boys age 7-13 and more than doubled for girls between the early 1980s to mid-2000s 2.Childhood-onset obesity is more likely to persist into adolescence and adulthood 3.Risks include cardiovascular problems, diabetes, and elevated cholesterol and triglycerides -Obesity is a major factor in reducing life expectancy in North America -Preadolescent obesity is a risk factor in the later emergence of eating disorders 4.Culture and SES: -Among U.S. children and adolescents: more prevalent in minority cultures -U.S. has the highest percentage of overweight children ->Problems for low-income populations: ->Low cost and availability of fast food and junk food ->Diminished physical activities due to living in unsafe neighborhoods

Maturational Changes

1.Infants and Toddlers •Night-waking problems 2.Preschoolers •Falling-asleep problems 3.Younger school-aged children •Going-to-bed problems 4.Adolescents •Difficulty going to or staying asleep •Not having enough time to sleep •Have increased physiological need for sleep •Often get less sleep than needed

Intervention and Treatment: Physical Abuse and Neglect

1.Interventions emphasize desired changes in parental behavior, but also affect children's development -Abuse: Must address how parents teach, discipline, and attend to their children -Neglect: Focus on parenting skills and expectations 2.Treatment often begins with efforts to increase positive parent-child interactions and pleasant experiences 3.Cognitive-behavioral approaches are most effective -Modify parental behaviors relevant to child maltreatment -Relaxation, self-management skills training, cognitive restructuring, problem-solving, and stress and anger management combined with basic child-rearing skills 4.Treatment for neglect focuses on ways to stimulate child development and structure child activities plus basic education and assistance in managing everyday demands 5.Programs for maltreated children show improved social behavior, cognitive development, self-concept, and reduced aggressive and coercive behaviors 6.Treatments try to restore child's sense of trust, safety, guiltlessness -Information and education; reassurance; group therapy -Learn ways to prevent sexual abuse and restore sense of personal power and safety 2.Cognitive-behavioral methods for children and non-offending parents 3.Child needs to express feelings about the abuse and may need specialized treatment if suffering from PTSD -Gradual exposure, modeling, education, coping, and prevention-skills training

Physical Abuse and Neglect: Offender Characteristics

1.Less interaction with their children than other parents 2.Information-processing disturbances 3.Lack child-rearing and information-processing skills 4.Poor anger management skills 5.Neglecting parents more likely to: -Exhibit personality disorders -Exhibit inadequate knowledge of child's needs -Disengage under stress (escape and avoidance)

Treatment

1.Main line of attack: -Exposure to anxiety producing situations, objects, and occasions 2.Modify: -Distorted information processing -Physiological reactions to perceived threat -Sense of a lack of control -Excessive escape and avoidance behaviors

Medications

1.Medications can reduce symptoms, especially for OCD 2.The most common and effective medications are selective serotonin reuptake inhibitors (SSRI's), especially for OCD 3.Less consistent findings regarding effectiveness in treating other anxiety disorder 4.Most effective when combined with CBT, which is the first line of treatment

Biological Regulators

1.Metabolic rate (balance of energy expenditure): based on individual genetic and physiological makeup and eating and exercise habits 2.Body weight: -An individual's natural weight is regulated by his or her own body weight set point -Set point: comfortable range of body weight that the body tries to "defend" and maintain Growth: 3.Physical growth rate dependent on the growth hormone (GH) and thyroid hormone

Associated Problems and Adult Outcomes of PTSD

1.Mood and Affect Disturbances -increased symptoms of depression, emotional distress, suicidal ideation common in children with PTSD -increased risk of substance abuse -May lead to eating disorders -Expression may vary -Disassociation: altered state of consciousness 2.Emotional and Behavioral Problems -Girls more internalizing of symptoms while boys are more externalizing. -Children's relationships are modeled after those they experience -Poor adjustment in school and interpersonal relationships often leads to higher rates of physical and mental health problems 3.Sexual Adjustment -Traumatic sexualization: child's sexual knowledge and behavior shaped in developmentally inappropriate ways -Children may be indiscriminate in their physical affection towards others -Sexual abuse may lead to: ->weight problems and eating disorders ->physically destructive behavior ->promiscuity, prostitution, sexual aggression, and victimization of and by others (in early adulthood) 4.Unhealthy relationships -Cycle-of-violence hypothesis: victims of violence have greater chance of becoming perpetrators of violence -Correlation between history of maltreatment or trauma and subsequent arrests. -Authoritarian parenting style

Definition and Classification of Eating Disorders

1.Must consider three areas when making a diagnosis: -Individual's weight -Does individual engage in binging? -Method person uses to control his/her weight

neurobiological factors

1.No single structure or neurotransmitter controls the entire anxiety response system 2. Overactive behavioral inhibition system (BIS) implicated 3.Brain abnormalities have been implicated in children who are anxious and/or behaviorally inhibited -more pronounced right-left hemisphere brain asymmetries -an over-excitable amygdala 4. Primary neurotransmitter system implicated in anxiety disorders: γ-aminobutyric acid-ergic (GABA-ergic) system

Enuresis: Prevalence and Course

1.Nocturnal enuresis: prevalence declines rapidly as children mature -Diurnal enuresis is much less common 2.Primary enuresis: continence has never been attained (85% of children with enuresis) 3.Secondary enuresis: control was established and then lost (less common) 4.Associated psychological distress depends on: -Limitations on social activities -Effects on self-esteem -Parental reactions

Developmental Course of Anorexia

1.Onset between ages 14 and 18 2.Often begins with dieting that gradually leads to life-threatening starvation 3.Most common course: fluctuations between recovery and relapse 4.6-10% die from medical complications or suicide 5.Worse outcomes are correlated with longer duration of illness, bingeing and purging, and comorbid affective or anxiety disorders

Developmental Course of Bulimia

1.Onset: late adolescence and young adulthood 2.Binge eating often develops during or after period of restrictive dieting 3.May follow a chronic course or occur intermittently 4.Between 50-75% show full recovery over several years 5.Best predictors of favorable outcome: -younger age at onset -higher social class 6.Single best predictor or risk for developing an eating disorder is being an adolescent female 7.The biological dimension: -Play only a minor role -Likely contributes to maintenance of disorder because of effects on appetite, mood, perception, and energy regulation 8.Genetic and constitutional factors: -Inherit a biological vulnerability that interacts with social and psychological factors 9.Neurobiological factors: -Imbalances of serotonin, which regulates hunger and appetite, may be implicated -Biochemical similarities have been found between people with eating disorders and those with OCD -Social dimension: -Features of contemporary Western culture may be implicated in eating disorders -Evidence that bulimia is primarily related to Western culture -Orthorexia

Causes of PTSD

1.Originates from severe trauma or threat 2.How trauma is experienced depends on multiple factors: -Developmental level of child -Pre-disaster characteristics (i.e. level of anxiety and stress) 3.Contributing causes to PTSD include: -Poor emotion regulation -Emerging view of self and others - neurobiological changes 4.Poor Emotion Regulation -Trauma and stress can disrupt parent-child attachment -These children often display insecure-disorganized attachment -Emotions provide important signals about our internal and external worlds 4.Emerging View of Self -Emotional and behavioral problems likely to emerge due to maladaptive view abused child has of themselves. -Maltreated children lack core positive beliefs about themselves -Sense of personal power can be undermined. 5.Neurobiological -Children with a history of maltreatment show long-term alterations in the HPA axis and norepinephrine systems -Acute and chronic forms of stress associated with maltreatment may cause changes in brain development and structure from an early age -Neuroendocrine system becomes highly sensitive to stress, causing neurobiological changes that may account for later psychiatric problems

Social and Cultural Dimensions

1.Our society condones and glorifies violence 2.Media and entertainment present stereotypical portrayals of females and males 3.Racism and inequality are major sociocultural factors that contribute to abuse and neglect 4.Lack of social connections 5.Cultural norms influence the prevalence of sexual abuse

Features of Sleep Disorders

1.Parasomnias: Disorders in which behavioral or physiological events intrude on ongoing sleep -Involve physiological or cognitive arousal at inappropriate times during sleep-wake cycle -Include nightmares, sleep terrors and sleepwalking 2.Diagnosis for all sleep-related disorders requires: -Clinically significant distress/impairment -The disturbance cannot be better accounted for by another mental disorder, effects of a substance, or general medical condition

Sexual Abuse: Offender Characteristics

1.Pedophile: person who engages in sexual acts with minor children or youths 2.Most have significant social and relationship deficits 3.Over 50% of pedophiles are aware of their interests before age 17 4.Use complicated techniques to gain access and compliance from the child 5.Often a perpetrator has special status 6.Offenders often have their own histories of abuse

SUD: Causes

1.Personality characteristics: -increased sensation seeking: preference for novel, complex, and ambiguous stimuli -Positive attitudes about substance abuse (high perceived benefit and acceptability, low perceived risk) and having friends with similar attitudes -School disconnectedness -Peers and culture: -Association with deviant and substance-using peers -False consensus ("everyone's doing it") Substance use glamorized by peer culture

Neglect

1.Physical Neglect •refusal or delay in seeking health care •expulsion from the home •refusal to allow a runaway to return home •abandonment •inadequate supervision 2.Educational Neglect •allowing chronic truancy •failing to enroll a child of mandatory school age in school •failing to attend to a child's special educational needs 3.Emotional Neglect •marked inattention to a child's needs for affection •refusal or failure to provide needed psychological care •spousal abuse in the child's presence •permission of drug/alcohol use by the child

Abuse

1.Physical abuse: -multiple acts of aggression, including punching, beating, kicking, biting, burning, shaking, or otherwise physically harming a child 2.Injuries are often the result of over discipline or severe physical punishment 3.Psychological abuse: -repeated acts or omissions that may cause serious behavioral, cognitive, emotional, or mental disorders

DSED and RAD

1.Prevalence and Onset -Applied to children between 9 months and 5 years -DSED is more persistent -RAD often disappears once children are adopted 2.Causes and Treatment -Stem from grossly inadequate care -Unknown what vulnerabilities determine course -Treatment focus is on improving caregiving quality

Bulimia Nervosa

1.Primary feature: binge eating 2.A binge is an episode of overeating that must involve -An objectively large amount of food -Lack of control over what or how much food is eaten 3.Attempt to conceal binge eating out of shame 4.Second important feature: compensatory behaviors 5.Two types of compensatory behaviors: -Purging: regularly engages in self-induced vomiting or misuse of laxatives, diuretics, or enemas -Non-purging: use of other inappropriate compensatory behaviors, such as fasting or excessive exercise 6.Thinking is rigid and absolutistic (all or nothing attitude) -Greater dissatisfaction with body proportions and distort true body size 7.Medical consequences are severe, but not as severe as consequences resulting from anorexia: -Fatigue, headaches, loss of dental enamel, menstrual irregularity or amenorrhea

Treatment for Parasomnias

1.Prolonged treatment of parasomnias is usually not necessary 2.Treatment of nightmares: -Provide comfort at the time of occurrence -Attempt to reduce daytime stressors 3.Parents of sleepwalkers should take precautions to avoid chances of child being injured -Excessive fatigue or unusual stressors during daytime often precipitate sleepwalking -Brief afternoon naps may be beneficial

Treatment

1.Psychological interventions: individual and/or family-based psychotherapy, sometimes accompanied by medical interventions -Effectiveness is weak, especially for anorexia nervosa but better for bulimia -Family-based interventions receiving increasing support -Most can be managed as outpatients -Hospitalization 2.Pharmacological: antidepressants (not for initial treatment) and SSRIs may be helpful for bulimia, but not anorexia -Should be used in conjunction with CBT, not just medication by itself 3.Psychosocial interventions: comprehensive treatment plans with psychotherapist, nutritionist, psychopharmacologist, and internist are more effective than medications alone -Resolution of family and interpersonal problems 4.Anorexia Treatment -Generally less responsive to treatment than bulimia -Family interventions are often required to restore healthy communication patterns -Address family's attitudes towards body shape and image 5.Bulimia: -Individual or family oriented CBT -Change eating behaviors with rewards and modeling -Help patients change distorted or rigid thinking patterns -Address underlying interpersonal issues -Interpersonal therapy addresses situational and personal issues contributing to the development and maintenance of the disorder

Reactive Attachment Disorder (RAD)

1.RAD: pattern of disturbed and developmentally inappropriate attachment behaviors -Do not seek comfort nor respond to efforts to comfort -Little positive emotion during interaction with caregiver -Compromised emotional regulation 2.Linked to problems with early caregiver-child relationship

DSM-5: Trauma and Stressor-Related Disorders

1.Reactive Attachment Disorder 2.Disinhibited Social Engagement Disorder 3.Acute Stress Disorder 4.Adjustment Disorder 5.Posttraumatic Stress Disorder (PTSD)

Trauma and Stressor-Related DSM-5 Disorders

1.Related to social neglect -Reactive Attachment Disorder (RAD) -Disinhibited Social Engagement Disorder (DSED) 2.Related to stress and trauma -post-traumatic Stress Disorder (PTSD)

Family Context

1.Relational disorder: maltreatment occurs during periods of stressful role transitions for the parents 2.Multiple causes 3.Not typically caused by adult psychopathology 4.More common among the poor and disadvantaged

Adolescent Substance Use Disorders (SUD)

1.Results from self-administration of any substance that alters mood, perception, or brain functioning 2.Include: -Substance dependence -Substance abuse -Risk for psychological and physical dependence

Binge Eating Disorder (BED)

1.Similar to bulimia without the compensatory behaviors 2.Involves periods of eating more than other people would, accompanied by feeling of loss of control 3.Individuals are often overweight or obese 4.Youth with BED: -Score lower on body satisfaction and self-esteem -Score higher on depressive mood -More likely to report that weight and shape are very important to their overall feelings about themselves

Sleep Disorders

1.Sleep is the primary activity of the brain during the early years of development -By age 5, the sleep/wake cycle is more evenly balanced 2.A bidirectional relationship exists between sleep problems and psychological adjustment -Sleep disorders can cause emotional and behavioral disorders -Sleep disorders can result from other disorders 4.Sleep disorders can mimic or worsen symptoms of major disorders

The Regulatory Functions of Sleep

1.Sleep, arousal, affect, and attention are all closely intertwined 2.Sleep is essential for: -Brain development -Regulation of states of emotional arousal and restoration 3.Sleep deprivation impairs functioning of the prefrontal cortex

Anxiety and depression

1.Social phobia, GAD, SAD, and multiple anxiety disorders (not specific phobia) are commonly associated with depression -Negative affectivity: persistent negative mood, as reflected in nervousness, sadness, anger, and guilt ->Related to anxiety and depression -Positive affectivity: persistent positive mood that includes states such as joy, enthusiasm, and energy ->Negatively correlated with depression - Physiological hyperarousal (somatic tension, shortness of breath, dizziness,

prevention

1.Study on 4 year olds: -Intervention group had less anxiety disorders and lower symptom severity 2.Universal programs of primary prevention have also been successful in preventing anxiety in older children

family and genetic risk

1.Tendencies to be inhibited, tense, or fearful is inherited 2.About 1/3 of the variance in childhood anxiety symptoms is genetic. 3. 5 times more likely to have anxiety disorder if you have parents who have anxiety disorders 4.Serotonin and dopamine systems are related to anxiety 5.Genes are linked to broad anxiety-related traits (e.g., behavioral inhibition); small contributions from multiple genes, but no direct link with specific genes

traumatic vs stressful events

1.Traumatic Events: exposure to actual or threatened harm or fear of death or injury, they are considered uncommon or extreme stressors 2.Stressful Events: more common and less extreme than traumatic events

Eating Disorders of Adolescence

1.Two important periods of adolescence for eating disorders: -Early passage into adolescence -Transition from later adolescence to young adulthood 2.Teens attempt to exert excessive control over their eating as a way to manage stress and physical changes 3.Ideal body sizes vary with time and culture preferences

Causes: Sociocultural Factors

1.Western culture: -Self-worth, happiness, and success are determined primarily by physical appearance 2.Teenage girls: -Weight loss and being skinny are more important than sexual issues, alcohol and drug abuse, mental health, disease, and environmental issues -Influences of mass media on body dissatisfaction

SUD: Causes

1.family background -Neurobiological factors: inherit certain brain structures and functional abilities from one or both parents -Child rearing and family functioning (i.e. lack of parental monitoring) -Trust between adolescent females and their parents is a strong deterrent for risk behaviors =Other risk factors: poor parent-teen communication, and family conflict

Sexual Abuse

1Sexual abuse: Fondling a child's genitals, intercourse with the child, incest, rape, sodomy, exhibitionism, and commercial exploitation through prostitution or the production of pornographic materials -May significantly affect behavior, development, and physical health of child -Reactions and recovery depend on the nature of the assault and responses of important others -Constitutes a breach of trust, deception, intrusion, and exploitation of a child's innocence and status

Accompanying Disorders and symptoms

ADHD 1. more than 50% of children with CD also have ADHD 2. possible reasons for overlap: - A shared predisposing vulnerability may lead to both - ADHD may be a catalyst for CD -ADHD may lead to childhood on set of CD 3. research suggests that CD and ADHD are distinct disorders Depression and Anxiety 1. approximately 50% diagnosed with depression or anxiety - girls with CD develop depressive or anxiety disorder by early adulthood - Anxiety may serve as protective factor to inhibit aggression

ODD Symptoms

Angry/Irritable Mood 1. often loses temper 2.is often touchy or easily annoyed 3.is often angry and resentful Argumentative/Defiant Behavior 1.often argues with authority figures or, for children and adolescents with adults. 2. often actively defies or refuses to comply with requests from authority figures or with rules 3. often deliberately annoys others 4. often blames others for his or her mistakes or misbehavior Vindictiveness 1. Has been spiteful or vindictive at least twice within the past 6 day months

Gender Differences

Boys 1. earlier age of onset and greater persistence 2. early symptoms for boys are aggression and theft 3. Remain more violence-prone over their lifespan Girls 1. early symptoms for girls are sexual misbehaviors 2. girls more likely to engage in relational aggression

Developmental Pathways

Life-course-persistent (LCP) 1. Path begins early and persists into adulthood 2. antisocial behavior begins early because of subtle neuropsychological deficits that heighten vulnerability to antisocial elements in social environment 3.complete, spontaneous recovery is rare after adolescence 4. associated with family history of externalizing disorders 5. Antisocial behavior is stable for youths on the LCP path, who continue on the same road Adolescent-limited (AL) 1. path begins around puberty and ends in young adulthood 2. less extreme antisocial behavior, less likely to drop out of school, and have stronger family ties 3. some continue to display antisocial behavior, often as a result of snares 4. antisocial behavior is unstable for those on the AL path

Normal Worries and Rituals

Normal Worries - serves a function in normal development - moderate worry can help children prepare for the future - children with anxiety disorders worry more intensely Normal rituals and repetitive behavior - ritualistic and repetitive actively is common - helps children gain control and mastery of their environment -many common childhood routines involve repetitive behaviors

Posttraumatic and Acute Stress Disorders

Posttraumatic Stress Disorder •Persistent anxiety following an overwhelming traumatic event that occurs outside the range of usual human experience. •Core features are: •Symptoms of intrusion: flashbacks •Avoidance of distressing memories •Distortions in thoughts and feelings •Persistent symptoms of extreme arousal and reactivity Acute Stress Disorder •Development of at least 9 symptoms within one month after traumatic experience, •Duration: 3 days - 1 month

Depression and Development

Preschoolers: - may appear extremely somber and tearful, lacking exuberance, bounce, and enthusiasm -may display excessive clinging and whiny behavior around mothers and fear of separation or abandonment -irritability School age: - show similar symptoms as preschoolers -increasing irritability, disruptive behavior, tantrums, and combativeness Preteen - show similar symptoms -self-blame and low self-esteem -persisten sadness and social inhibition

Theories of Family influences

Reciprocal influence 1. child's behavior is influenced by and influences the behavior of others 2. child behaviors exert greater influence on parenting behavior than the reverse. Coercion Theory 1. parent-child interactions provide a training ground for the development of antisocial behavior 2. four-step escape- conditioning sequence 3. children with callous-unemotional traits display significant conduct problems regardless of parenting quality Attachment Theory 1. children with conduct problems show little internalization of parent and societal standards 2. relationships between insecure attachments and the development of antisocial behavior

Oppositional

Temper tantrums argues annoys others stubborn angry defies adults touchy

conduct problems

conduct problems and antisocial behaviors: age- inappropriate actions and attitudes that violate family expectations, societal norms and personal or property rights of others - disruptive and rule-violating behaviors -range from annoying minor behaviors to serious antisocial behaviors

Aggression

cruel to animals spiteful cruel assault fights bullies

psychodynamic

depression results from the actual or symbolic loss of a love object

socio-environmental

emphasize the relationship between stressful life events and depression

neurobiological

emphasize the role of genetic vulnerabilities and neurobiological abnormalities

attachment

parental separation and disruption of an attachment bond are predisposing factors for depression

Status offenses

runs away truancy uses substances swears

Separation Anxiety Disorder

separation anxiety Disorder (SAD): - age-inappropriate, excessive, and disabling anxiety about being apart from major attachment figure separation anxiety is important for a young child's survival - age 7 months- preschool years it is normal -lack of separation anxiety at this age may suggest insecure attachment -if anxiety persists for at least 4 weeks and is severe, child may have separation anxiety disorder.

Covert-property Destructive

steals fire setting vandalism lies

self-control

view depression as associated with difficulties in organizing behavior in relation to long-term goals

interpersonal

view disruptions in relationships as the basis for the onset and maintenance of depression

Family influences

when children are depressed - families more critical and punitive toward depressed child than toward other children -strong link between childhood depression and family dysfunction when Parents are depressed - Depression interferes with the parent's ability to meet the basic physical and emotional needs of the child -intrusive vs withdrawn -cognitive deficits, emotional delays, separation difficulties insecure attachments, and less positive affect -Experience increased rates of depression before puberty, and higher rates of phobias, panic disorders, and alcohol dependence as adolescents and adults