PSYCH-Abnormal Behavior in Children- 2
Treatment for Pica and Rumination Disorder
Differential reinforcement of incompatible behaviors Food replacement (pica) similar item to the actual food Punishment
Risk Factors for Rumination Disorder
Difficulties Social Functioning Difficulties usually emerge in infancy Prevalence not clear Medical conditions: malnutrition, weight loss, death
Primary Type
Never established contience- never had controll
Child Insomina Factors/Risk
1. Difficult temperament 2. ADHD 3. Medical problems 4.Anxiety/worrying 5. Parental Factors: established bedtime routine Classical Conditioning- parent can condition to NOT fall alseep on their own Operant Conditioning- when parents gives in to the child-
What are the four different aspects of traumatic events that are important to consider when determining the risk for posttraumatic stress disorder?
1. Intrusion Symptoms: recurrent memories, flashbacks 2. Avoidance Symptoms: avoid people, places,situations 3. Alterations in cognition or mood(dissociative symptoms)difficulties with memory, negative beliefs about self 4. Alterations in arousal & reactivity: hypervigilance, irritability, and extreme response
What are the 4 pathways that increase the likelihood of experiencing poly-victimization?
1. Living in a dangerous community- exposure to valence & crime, neighborhood chaos, lack of social ties and support 2.Living in a dangerous family: involves intrafamily maltreatment that leads to emotional dysregulation and problematic peer interactions, which in turn lead to an individual being the target of bullies 3. Having a chaotic, multiproblem family environment: May include parental illness, unemployment, psychiatric disorders, and poor supervision and neglect, all of which are associated with vulnerability in both family and peer contexts. 4. Having emotional problems that increase risky behaviors and compromise adaptation: is a pathway possibly related to temperament; characteristics perceived as annoying, frustrating, disruptive, or overly passive lead to heightened risk for maltreatment in family and peer contexts.
5 stages of sleep cycle
1. NREM 1 Light sleep 2. NREM 2 Light Sleep 3. NREM 3 Deep Sleep 4. NREM 4 Deep Sleep 5 REM sleep- Rapid Eye movement- Dream state 1.15 hours is one course of sleep cycle
Enuresis Subtypes
1. Nocturnal Only at night 2 Diurnal only(while awake) Incontinence (can't hold it) Voiding Postponement-(hold it to the last min) 3.Nocturnal and diurnal- Urges
Screening of children for ASD is part of Dr. Appleton's standard protocol for well-baby care protocol. How old is a child when she generally makes a formal diagnosis of ASD?
3 years old
Every year, there are _____ reports of maltreatment made in the United States.
3,000,000
Rick is a 14 month old toddler that does not seem to be distressed when separated from his caregiver. When he gets distressed, he will consistently try to soothe himself, and he is not receptive to his parents' efforts to comfort him. Rick is most likely exhibiting which of the following attachment styles?
Ambivalent Attachment
What brain regions are involved in the stress response system?
Amygdala Frontal Cortex Hippocampus Circuitry that connects those regions
Which of the following terms represents a child's pattern of emotional and physiological reactivity and self-regulatory tendencies that is present early in development?
All of the above
1. What are some common treatments for avoidant/restrictive food intake disorder?
Appetite Manipulation (increase motivation to eat- have a child skip meal, so they are hungry) Change antecedents to eating (change behavior-reinforce in positive way) Contingency management (change of consequences
Screening Sleep Difficulties
B- bedtime Difficulites (weight, mood, development) E= Excessive Sleepiness- go to sleep, sleepy during day A=awkenings during night R-regular sleep-wake scchedule Snoring
According to Brian Johnston, the teacher in the video, what did his students select for their number one classroom rule?
Be a role model.
Which of the following interventions for insomnia disorder involves delaying a child's bedtime, usually around 30 minutes (but can be more) to help facilitate the child getting to sleep on his or her own. Then, after the child is able to get to sleep regularly without difficult at that time, the bedtime is moved earlier in small increments until the child is able to get to sleep at the desired bedtime?
Bedtime Fading
What are the gender differences in the risk of experiencing a traumatic event?
Boys are more likely to experience traumatic events, but girls are more frequently diagnosed with PTSD. The effects of gender may be stronger for older youth
How does temperament relate to adjustment?
Children with easy temperament are better adjusted to change and transitions Temperament- reactive and regulations
What are the 4 pathways that characterize the course of symptoms of posttraumatic stress disorder?
Chronic dysfunction(w/out recovery) Delayed breakdown pathway Response & Recovery Resilience
What interventions have empirical (i.e., research support) support as being effective in the treatment of posttraumatic stress disorder?
Cognitive and cognitive-behavioral approaches for PTSD have received the most empirical support Trauma-focused cognitive behavior therapy
Why is it important to consider the reason for the eating of nonnutritive, nonfood objects when considering the diagnosis of pica? What three reasons must one rule out to diagnose pica?
Differential diagnosis: Differentiating between two or more similar conditions or disorders 1. controlling appetite 2. falsify physical symptoms 3. intentional self-injury
Dawn is having a problem wetting the bed at night. So, Dawn's mother has brought her to her pediatrician. After a physical exam, the pediatrician suggested there did not appear to be a physical cause for Dawn's bedwetting. The pediatrician recommended that Dawn's mother should try rewarding Dawn for each night she can remain dry throughout the night. So, Dawn's mother started awarding Dawn a star on a chart for every might Dawn was able to remain dry. For every three stars Dawn earns, she get to pick out a toy from the local dollar store. Dawn's mother is instituting which of the following interventions?
Dry Bed Training
Characteristics of Feeding and Eating Disorder
Eating or eating related behaviors Consumption or absorption of food Health or psychosocial function
Tyler is afraid of sitting on the toilet to defecate. So, he tends to avoid defecating for days at a time. When doing this, his stool tends to get very hard. When his body can no longer hold much more fecal material, some fecal material begins leaking out of his anus. Tyler's symptoms are best described as...
Encopresis w/ constipations with overflow inconttinence
For a diagnosis of an elimination disorder, the difficulties associated with urinating or defecating in appropriate places need to be involuntary.
False
Insecure patterns of attachment are synonymous with psychological disorders that are common in childhood.
False
what are the gender differences in temperament?
Girls scored higher than boys on the Positive Affectivity scale. Temperament, especially the dimensions Negative Affectivity and Effortful Control, proved strongly predictive of both Depressive and Aggressive mood in all ethnic groups. These temperament traits include: 1.surgency (i.e., sociability and positive emotionality) 2.negative affectivity (i.e., predispositions to experience fear and frustration/anger) 3.effortful control (i.e., infant attempts to regulate stimulation and response). Differences in effortful control are frequently discussed in the context of arousal and emotion
Which of the following focuses on a potential physiological cause for autism spectrum disorder?
Growth dysregulation hypotheses
Causes/Etiolgogy of Non-REM
Highly Heritable Immature neural networks of inhibiting ANS arousal Sleep Deprivation & Fatigue Sleep wake scchedule disruptions Physical & EMotional Stress Fever
Encopresis Treatment
Laxatives, Fiber, lubricants Warm Baths Operant Conditioning
Sleep Patterns
Infancy-14-16 hours of sleeps Young Children 10-12 hours Adults 8 hours
Why might someone develop avoidant/restrictive food intake disorder?
Infants too sleepy, distressed or agitated to feed Infants & toddlers fail to communicate hunger sensory aspects of foods aversive consequences of food distractions during feeding Failure to meet nutritional/energy needs by (1 or more) *weight loss/failure *nutritional deficiency (not getting enough) *dependence on enteral feeding or supplements *Interference w/ psychosocial functioning It cannot be due solely to another medical cond. or be comorbid w/another eating disorder
Sleep-Wake Disorders
Insomnia Disorer Non-rapid eye movement sleep arousla disorders Nightmare Disorder Breathing-
Risk Factors for Enuresis
Lax or delayed toilet training Psychocial stress Irregular ciradian rhythms of urine production Bladder capacity Bladder hyperactivity Family Hisory Gender(more common in males)
1Why might young children be especially vulnerable to traumatic experiences?
Long-term difficulties associated with early trauma include problems with regulation of emotions and behavioral impulses, as well as problems with memory and attention, self-perception, and relationships.
Are maltreated children more likely to experience insecure attachments?
Maltreated children are much more likely to display insecure attachments, particularly disorganized attachments, than non-maltreated children
Remission
Most children who experience it by the age of 5 gets better/grows out of it Longer it goes on difficulites causes social & emotional emerges
Nightmare disorder treatment
Most treated informally Assessment of stressors Improving sleep hygiene Relaxation and coping skills Nightmare imaagery rehearsal therapy: rewrite nighmares or resillience (formal intervention)
Were children always thought to be capable of experiencing posttraumatic stress?
NO, It was thought to be associated with forgetting and "bouncing back"
What three factors contribute to infant's emotionality?
Negative affectivity, Surgency Effortful control
Managing Non-REM Sleep Arousal Disorder
No empirically supported treatment Suggestions: Reassurance and comfort goes Assisting in return to sleep if necesary Precautions to avoid danger
Encopresis
Passage of feces in inappropriate places. 1 event per month for 3 months At least 4years old Overflow incontinece- when new feces leaks out over impacted bowel
Contextual Factors
Physical sleeping environment light/tv screens delays the ability to sleep
According to the life-cycle model of stress and brain development, when do stressors and traumatic events have programming effects on genetic information?
Prenatal and Postnatal Stress- changes in gene function Life Cycle Model: of stress describes changes in various brain structures related to the timing of stress Prenatal Period Infancy Childhood Adolescence Adulthood
What are the different families of coping strategies identified in Table 8:1, and be able to identify examples of these coping responses?
Problem Solving: Strategizing Instrumental action Planning Information Seeking: Reading Observation Asking others Helplessness: Confusion Cognitive interference Cognitive exhaustion Escape: Behavioral avoidance Mental withdrawal Denial Wishful thinking Self-Reliance: Emotion regulation Behavior regulation Emotional expression Emotion approach Support Seeking: Contact seeking Comfort seeking Instrumental aid Social referencing Delegation: Maladaptive help seeking Complaining Whining Self-pity Social Isolation: Social withdrawal Concealment Avoiding others Accommodation: Distraction Cognitive restructuring Minimization Acceptance Negotiation: Bargaining Persuasion Priority setting Submission: Rumination Rigid perseveration Intrusive thoughts Opposition: Other-blame Projection Aggression
Epigenetics
Programming effects of stress or trauma during prenatal or postnatal or the environmental regulation of gene expression
Based on the Table 6:1 in the required reading, which of the attachment disorders is most easily treated?
Reactive attachment disorder. Oftentimes, when children with this disorder are placed in a more consistent and secure environment, they tend to start functioning better. Avoidant and ambivalent attachment are attachment styles, not disorders. So, neither of those responses could be correct.
Nightmare Disorder
Recurrent experiences of extended dysphoric, & easily remembered dreams. Upon awakening, the person is oriented and alert. Increases between age 10-13 Decreases in adult males, increase in adult females Content of Nightmares across development and gender
Non-REM Sleep Arousal Disorder
Repeated episodes of incomplete awakening from sleep with either (subtypes): sleep-walking (sitting up or walking) Sleep-related eating Sleep-related sexual behavior - sleep terrors Characterized by: - episodes occurring w/in first 1/3 of sleep (SWS) - no/little dream imagery - amnesia for episodes
According to the life-cycle model of stress and brain development, what are the impacts of rising and lowering levels of glucocorticoids at the various periods of development?
Rising Glucocorticoids Infancy- programming effect Toddlers -Maternal seperation 20-60-Depression 60+ Cognitive Decline Lowering Glucocorticoids 4-10 severe trauma 20-60 PTSD 60+ PTSD
What does the American Academy of Child and Adolescent Psychiatry recommend when it comes to assessing posttraumatic stress disorder in children and adolescents?
Routine screening for PTSD during all initial mental health assessments With parent invovlement
Treatment of Enuresis
Rule out medical or physical conditions Seek Professional Urine Alarm Cleanliness Training Night awakening Dry Bed Training (reinforce behavior with reward) Retention control training Medications
Breanna is an 18 month old girl. Breanna feels that her father is a person that she can turn to for comfort and support when needed. In attachment terms, Breanna's father would be called...
Safe Haven
Treatment for Insomina
Sleep Hygiene Intervention- education about behaviors, routines and environmental conditions that promote restful sleep Planned Ignoring: placing a fed, dry, and drosy infant to the crib, ignoring protest until sleep overcomes the infant Graduated Ignoring- ignoring protest for a period of time, parents enters the room breiefly leave process is repeated until they fall alseep Bedtime Fading (getting adjusted to new bedtimes before it happens) Cognitive Behavioral Training (older children) (1st Line of Defense) Medications
While sleeping, Tyrone repeatedly sits up in bed and will let out panicky, sometimes chilling screams. He appears awake, but is not responsive to efforts to comfort him. Most of the time, the screams will suddenly stop, and he will just lay back down and go to sleep like nothing happened. If he wakes up during the episode, he has no recall of the thing that made him scream. These screams are so disruptive that they wake everyone else in the home when they occur. Tyrone is most likely exhibiting...
Sleep Terrors
Children with ADHD are at an increased risk for experiencing insomnia.
True
For most children who exhibit symptoms of non-REM sleep arousal disorder, the symptoms tend to go away with development.
True
Why does the discontinuous model of temperament identify the temperament of only about
The other amount is a mix or combo of young children
What is the difference between the continuous and discontinuous models of temperament presented in the narrated lecture that provides background on early childhood and temperament?
To group children into categories based on the temperament 1. Easy Kids 40% 2. Difficult Kids 10% 3. Slow to warm up 15% Combo/Mix of all 35%
One of the important differences between the group home and the school is that the group home focuses first on _____
What the individual likes to do
It has been suggested that ADHD is a social construct related to permissiveness or the profit motives of drug manufacturers. Which research finding discussed in Chapter 9 seems to indicate that ADHD is a "real" disorder?
When research finds differences in prevalence of ADHD, they appear to be due to differences in research methodologies.
1. Are there benefits to experiencing stress in childhood, and why?
Yes- stress experiences are typical and whose coping is supported by concerned adults, these interactions contribute to a sense of self-efficacy, accomplishment, and well-being. No- for an inadequately supported children that are frequent and severe: developmental outcomes are more likely to include significant distress and dysfunction
Insomnia Disorder
a dissatisfaction with sleep quantity or quality that involves: difficulty initiating maintaining sleep Early Morning awkenings
Risk factors for non-REM sleep arousal disorder include...
all of the above
Risk factors for pica and rumination disorder include...
all of the above
General medical conditions that are sometimes associated with pica include...
all of the above general medical complications arise bowel obstructions putrefaction nutritional and mineral deficiencies
Insomnia can involve which of the following?
all of the above: difficulties falling asleep difficulties maintaining, or staying asleep difficulties with early morning awakenings
Jovian uses his filmmaking to address issues such as _____. Chapter 7 notes that individuals with autism spectrum disorder recognize and express basic emotions such as anger, although they have difficulties with more complex emotions such as _____.
anger; embarrassment
Because Monique's son Terrence has ASD and communicates little, she has learned to interpret his particular behaviors. She knows that when Terrence stands and flaps his hands repeatedly, he usually is ________.
anxious
Alma is experiencing avoidant/restrictive food intake disorder. So, with the help of a therapist, her mother is not allowing Alma to eat for several hours before meals. This intervention is called...
appetite manipulation
Unintentionally, I have been inconsiderate to a colleague at work. I should apologize to the colleague, but I do not like the colleague. So, I do not want to apologize. However, because I should apologize, I force myself to apologize. This is an illustration of which of the following important aspects of temperament in children?
behavioral control
Risk factors for reactive attachment disorder include...
both "a" and "b"
Non-REM sleep arousal disorder can include which of the following
both a and b Sleepwalking Sleep terrors
Which of the following interventions for insomnia disorder involves (or involve) ignoring a child's protests about being left alone in the child's bed to fall asleep.
both b and c
Kirby is 18 months old. Kirby's bedtime routine has involved his mother reading him a story and then rocking Kirby to sleep. Kirby has now associated being rocked by his mother with sleeping, and he cannot fall asleep without his mother rocking him. Which of the following risk factors for insomnia is illustrated in this example
classical conditioning
Julia is a 3-year old who is overly affectionate towards any adult who provides her attention, even in the presence of her parents. In fact, when distressed, she sometimes seems to prefer the comfort of strangers to the comfort from her parents. Which of the following is Julia most likely experiencing?
disinhibited social engagement disorder
Maggie's mother has been hospitalized for several months to treat her drug addiction. Because of her unavailability for parenting, young Maggie has had to attend a number of daycare environments. In some of these settings, she was maltreated by caregivers and older children. In times of stress, Maggie now engages in stereotyped movements and often looks afraid and apprehensive. Maggie is most likely exhibiting which of the following attachment styles?
disorganized attachment
After having learned to use the potty successfully for a year, Jack has started urinating in his pants three to four times a week for the past six months. It almost always happens while he is playing outside because he does not want to take a break from playing to urinate. So, he tries unsuccessfully to delay urination until he is done playing outside. Which of the following terms best describes the difficulty with urination that Jack is experiencing?
diurnal enuresis
Secondary Type
established continence, and regressed
The reading points out that to understand ADHD, it is important to focus on _____, or those cognitive processes that underlie goal-directed behavior and are orchestrated by activity within the prefrontal cortex.
executive function
Why would early exposure to moderate amounts of stress be beneficial to development
exposure to multiple instances of stress (or challenge) may be necessary for the typical development of problem-solving or coping strategies. Provides a developmental framework for thinking about coping.
What factors promote resilience in children who experience maltreatment and traumatic events
genetic predispositions child characteristics such as average or above-average intelligence positive emotionality and optimism perceived self-efficacy and better self-regulation relationship characteristics such as secure attachment and friendships
The "plaid" concept noted by Attwood (1998) reflects what aspect of autism spectrum disorder?
individual differences
Whereas children with a difficult temperament are at the greatest risk for ______ difficulties, children with a slow-to-warm-up temperament are at the greatest risk for ______ difficulties.
internalizing, externalizing
Acute Stress Disorder (ASD)
involves the display of multiple symptoms from any combination of categories (e.g., related to intrusion, dissociation, avoidance, and arousal) following exposure to a traumatic event. Acute stress disorder is diagnosed when the duration of symptoms lasts up to one month.
posttraumatic stress disorder (PTSD)
involves the experience of trauma and the display of symptoms from each category; PTSD is diagnosed when symptoms last longer than one month
Coping
involves the regulatory processes that are activated in response to stress (
Approximately 45% of deaths from maltreatment occur in children:
less than 1 year old.
Is Maltreatment a diagnosis?
maltreatment is not a diagnosis that is assigned to a child.
Anna wants and her brother are taking turns playing with a toy, and right now, it is her brother's turn to play with the toy. Anna is frustrated that she cannot play with the toy right now. So, in an effort to manage her frustration, she voluntarily starts playing with another, less desirable toy. Anna's efforts to manage her frustration by playing with another toy are best described as a part of which of the following aspects of infant emotionality?
negative affectivity
The most commonly reported form of child maltreatment is:
neglect
Risk Factors of Pica
neglect lack of supervision developmental delay Intellectual disabilities
The term _____ refers to the fact that different individuals have different modes and patterns of neurological functioning. The reading also points out _____ models of autism focus on the accumulating and cascading effects of multiple genes.
neurodiversity, polygenic
Courtney is in late childhood, and she is experiencing nightmare disorder. As part of her treatment, she has been instructed to write about her nightmares, but to change the endings so that her stories end with her overcoming the challenging events or defeating the monsters. This represents which of the intervention efforts that are commonly employed to treat nightmare disorder?
nightmare imagery rehearsal training
Children who have at one time established urinary continence (successfully able urinate in appropriate places), but then begin to regularly urinate in the bed while sleeping at night, would most likely be diagnosed with which of the following?
nocurnal enuresis, secondary type
Children with pica eat nonnutritive, nonfood substances...
none of the above
Terrance is a toddler and is a very picky eater. Though he will occasionally eat other foods, his typical diet consists largely of peanut butter and jelly, cereal, peas, and strawberry yogurt. Medical exams indicate that Terrance is making the expected weight gains for his age, and he is generally healthy. Terrance is most likely...
not experiencing an eating-related disorder.
Stress
occurs when the demands of the individual exceed his or her available resources.
George has been participating in a pharmacological research study that has produced a marked decrease in his social difficulties related to ASD. What type of medication is this study likely focused on?
oxytocin
Brian Johnston suggests that the most important advice for a new teacher working with students with ADHD is to be _____.
patient and flexible
Although Beth can speak, she is reluctant to do so, so the worker relies on _____ to communicate without pushing the issue of spoken language.
photographs
Non-REM Sleep Arousal Disorder- Sleep Terror
recurrent episodes of abrupt terror arousals from sleep, usually begining with a panicky scream 1/3 children experience it it's not uncommon
allostatic load
refers to the cumulative physiological and psychological wear and tear caused by ongoing (and sometimes maladaptive) allostatic processes.
Allostatsis
refers to the natural process of maintaining physiological and psychological stability in response to environmental demands
Rumination Disorder
repeated regurgitation of food several times per week for 1 month (cannot have any other eating disorder without w/excpection of pica)
What are the risk factors for maltreatment?
similar to PTSD- memory problems, sleep disturbances, behavior problems, emotions dysregulation, gene heredity
Tony is a young child who has a tough time managing his distress when his routines are broken, and when he is distress it is hard for his mother to soothe him. Tony most likely would be classified as having which of the following types of temperament?
slow-to-warm-up
The standard role of mirror neurons implicates them in which aspect of autism spectrum disorder?
social
Which of the following is NOT one of the core symptom areas of autism spectrum disorder?
social behavior
Which of the following would likely receive the most attention from an infant who demonstrates early signs of ASD?
the clothes dryer
Based on the required reading, what are the three biobehavioral shifts or touchpoints that signal important developmental periods of growth?
two and three months of age rhythmic rhythmic routines of feeding, dressing, comfort seven and nine months, another shift takes place 18 and 20 months. By then, toddlers are walking and talking
Whereas __________ interventions are designed to help everyone in a general population, _________ interventions are designed to help groups of people who are already experiencing specific risk factors for psychopathology.
universal; indicated
Why might abused children exhibit a hypersensitivity to angry faces?
with respect to overall emotional experience, maltreated children display difficulties with emotion processing and communication
Based on attachment theory, an internalized representation of one's self and the world is referred to as...
working model
