Chapter 15 – Disorders Of Childhood And Adolescence Flashcards Preview

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Flashcards in Chapter 15 – Disorders Of Childhood And Adolescence Deck (39)
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1
Q

What are five vulnerabilities to consider when evaluating the presence or extent of mental health problems in children and adolescents?

A
  1. They do not have as complex and realistic a view of themselves and their world as they will have later on; they have less self understanding; and they have not yet developed a stable sense of identity or a clear understanding of what is expected of them and what resources they may have to deal with problems.
  2. Immediately perceived threats are tempered less by considerations of the past or future and thus tend to be seen as disproportionately important. As a result, children often have more difficulty than adults in coping with stressful events.
  3. Children’s Limited perspectives, as might be expected, lead them to use unrealistic concepts to explain events. For young children, suicide or violence against another person may be undertaken without any real understanding of the finality of death.
  4. Children also are more dependent on other people then are adults. Although in some ways this dependency serves as a buffer against other dangers because the adults around him or her might protect a child against stressors in the environment, it also makes the child highly vulnerable to experiences of rejection, disappointment, and failure if these adults, because of their own problems, ignore the child
  5. Children’s lack of experience in dealing with adversity can make manageable problems seem insurmountable. On the other hand, although their inexperience and lack of self-sufficiency make them easily upset by problems that seem minor to the average adult, children typically recover more rapidly from their hurts
2
Q

Discuss general issues in the classification of childhood and adolescent disorders

A

Until the 1950s no formal, specific system was available for classifying the emotional or behavioural problems of children and adolescents. Current ways of viewing psychological disorders in children and adolescents were inappropriate and inaccurate for several reasons:
The greatest problem was that the same classification system that had been developed for adults was used for childhood problems even though many childhood disorders such as autism, learning disabilities, and school phobias, have no counterpart in adult psychopathology.
The early systems also ignored the fact that in childhood disorders, environmental factors play an important part in the expression of symptoms. Symptoms are highly influenced by families acceptance or rejection of the behavior.
In addition, symptoms were not considered with respect to a child’s developmental level.

3
Q

Disorder of childhood characterized by difficulties that interfere with task-oriented behavior, such as impulsivity, excessive motor activity, and difficulties in sustaining attention

A

Attention-deficit/hyperactivity disorder or ADHD

Perhaps as a result of their behavioural problems, children with ADHD are often lower in intelligence. Also tend to talk incessantly and to be socially intrusive and immature. Generally have many social problems because of their impulsivity and overactivity and have difficulty in getting along with their parents because they do not obey rules.
In general, they are not anxious even though their behaviours make it seem as if they are.

It is the most frequently diagnosed mental health condition in children in the US.
Occurs most frequently among preadolescent boys, being 6 to 9 times more prevalent among boys than girls. Occurs with the greatest frequency before age 8 and tends to become less frequent and to involve briefer periods thereafter. Also comorbid with other disorders such as oppositional defiant disorder.

Caused likely by both genetics and social environmental precursors. Temperament and learning appear likely to be factors.

Treatment: children are often prescribed medication, mostly Ritalin, an amphetamine, which decreases overactivity and distractibility and at the same time, increases their alertness. Side affects our decreased blood flow to the brain, which can result in impaired thinking ability and memory loss; disruption of growth hormone, leading to suppression of growth in the body and brain of the child; insomnia; psychotic symptoms. Shown to be effective in the short-term treatment, and there are new or variance of the drug referred to as extended release methylphenidate or Concerta. Other medications include pemoline, Strattera, and Adderall.
Psychological interventions include selective reinforcement in the classroom and family therapy. Also the use of behaviour therapy techniques featuring positive reinforcement and the structuring of learning materials and tasks in a way that minimizes error and maximize his immediate feedback and success.

Has a prevalence rate of 4.4% in adult patients.
Children may go on to have other psychological problems such as overly aggressive behaviour or substance abuse such as cocaine, and substantial increased risk for adult criminality. Girls were at high risk for antisocial, addictive, mood, anxiety, and eating disorders.

4
Q

Central nervous system stimulant often used to treat ADHD

A

Ritalin

5
Q

Drug, similar to Ritalin, used to treat ADHD. Exerts beneficial effects on classroom behaviour by enhancing cognitive processing but has less adverse side effects.

A

Pemoline

6
Q

A medication used in the treatment of ADHD. A non-controlled treatment option that can be obtained readily. A non-stimulant medication that reduces the symptoms of ADHD but it’s mode of operation is not well understood. Side effects are decreased appetite, nausea, vomiting, and fatigue and the development of jaundice has been reported

A

Strattera

7
Q

A habit forming drug comprised of a combination of dextroamphetamine and amphetamine. Reduce his symptoms of impulsivity and hyperactivity in children with ADHD. Has no advantage or improvement in results over Ritalin or Strattera.

A

Adderall

8
Q

Legal term used to refer to illegal acts committed by minors

A

Juvenile delinquency

9
Q

Childhood disorder that appears by age 6 and is characterized by persistent acts of aggressive or antisocial behaviour that may or may not be against the law.

The essential feature is a recurring pattern of negativistic, defiant, disobedient, and hostile behaviour toward authority figures that persists for at least six months. Usually begins by the age of eight.

A

Oppositional defiant disorder or ODD

Virtually all cases of conduct disorder are preceded developmentally by oppositional defiant disorder, but not all children with oppositional defiant disorder go on to develop conduct disorder within a three-year period. Risk factors for both include family discord, socioeconomic disadvantage, and antisocial behaviour in the parents

10
Q

Childhood and adolescent disorders that can appear by age 9 and are marked by persistent acts of aggressive or antisocial behaviour that may or may not be against the law.

Involves a persistent, repetitive violation of rules and a disregard for the rights of others. Children show a deficit in social behaviour.

Manifest such characteristics as overt or covert hostility, disobedience, physical and verbal aggressiveness, quarrelsomeness, vengefulness, and destructiveness. Line, solitary stealing, and temper tantrum’s are common. Tend to be sexually uninhibited and inclined toward sexual aggressiveness and some may engage into cruelty to animals, fire setting, vandalism, robbery, and even homicidal acts.

A

Conduct disorder

Frequently comorbid with other disorders such as substance abuse disorder or depressive symptoms. Risk factor for unwed pregnancy and substance abuse in teenage girls. Early onset is highly associated with later development of antisocial personality disorder.

11
Q

What are causal factors in oppositional disorder and conduct disorder?

A

A genetic predisposition leading to low verbal intelligence, mild neuropsychological problems, and a difficult temperament can set the stage for early onset conduct disorder. The child’s difficult temperament may lead to an insecure attachment because parents find it hard to engage in the good parenting that would promote a secure attachment. And the verbal intelligence and mild neuropsychological deficits help set the stage for a lifelong course of difficulties.

Children who develop conduct disorder at an earlier age are much more likely to develop psychopathy or antisocial personality disorder’s, then children who develop conduct disorder suddenly in adolescence. Link is stronger among lower socioeconomic class children. Most individuals who developed conduct disorder in adolescents do not go on to become adults psychopaths or antisocial personality but instead have problems limited to the adolescent years.

Psychosocial factors: children who are aggressive and socially unskilled are often rejected by their peers, and such rejection can lead to a spiralling sequence of social interactions with peers that exacerbates the tendency toward antisocial behavior. Parents and teachers may react to aggressive children with strong negative affect such as anger, and they may intern reject these aggressive children. The combination of rejection by parents, peers, and teachers leave these children to become isolated and alienated. Often turn to deviant peer groups for companionship, at which point a good deal of imitation of the antisocial behaviour of their deviant peer models may occur.
Family setting is typically characterized by an effective parenting, rejection, harsh and inconsistent discipline, and parental neglect. Parents have an unstable marital relationship, or emotionally disturbed or sociopathic, and do not provide the child with consistent guidance, acceptance, or affection.

12
Q

What are treatments and outcomes for oppositional disorder and conduct disorder?

A

The cohesive family model: attempts to modify the child environment. In this family-group oriented approach, parents of children with conduct disorder are viewed as lacking in parenting skills and as behaving in inconsistent ways, thereby reinforcing inappropriate behaviour and failing to socialize their children. Children learn to escape or avoid parental criticism by escalating their negative behavior, this tactic then increases their parents aversive interactions and criticism. The child observe the increased anger in his or her parents and models as aggressive pattern. The parental attention to the child negative, aggressive behaviour actually serves to reinforce that behaviour instead of suppressing it. Viewing conduct problems as emerging from such interactions places a treatment focus squarely on the interaction between the child and the parents.

Behavioural and biologically-based treatments: treating depression and oppositional defined behaviour with the antidepressant medication fluoxetine or Prozac and cognitive behaviour therapy may reduce oppositionality.
Teaching control techniques to the parents of such children is particularly important so that they can function as therapists in reinforcing desirable behaviour and modifying the environmental conditions that have been reinforcing maladaptive behaviour in their children.

13
Q

Describe the characteristics of children with anxiety disorders

A

Over sensitivity, unrealistic fears, shyness and timidity, pervasive feelings of inadequacy, sleep disturbances, and fear of school. May attempt to cope with their fears by becoming overly dependent on others for support and help. Often comorbid with depressive disorders. Greater preponderancy for anxiety-based disorder in girls than boys.

14
Q

Childhood disorder characterized by unrealistic fears, oversensitivity, self-consciousness, nightmares, and chronic anxiety.

The most common of the childhood anxiety disorders, reportedly occurring in 2 to 41% of children.

They lack self-confidence, or apprehensive in new situations, and tend to be immature for their age. Described by their parents as shy, sensitive, nervous, submissive, easily discouraged, worried, and frequently moved to tears. Typically are overly dependent, particularly on their parents. The essential feature is excessive anxiety about separation from major attachment figures, such as their mother, and from familiar home surroundings. In many cases, a clear psychosocial stress or can be identified, such as the death of a relative or a pet.

A

Separation anxiety disorder

May be caused by the contribution of genetic factors and social and cultural factors. Anxious children often manifest and unusual constitutional sensitivity that makes an easily conditional by aversive stimuli.
The child can become anxious because of early illnesses, accidents, or losses that involved pain and discomfort. The traumatic effect of experiences such as hospitalizations make such children feel insecure and inadequate. The dramatic nature of certain life changes such as moving away from friends and into a new situation can also have an intensely negative effect. These children often have the modelling effect of an over anxious and protective parent to sensitizes a child to the dangers and threats of the outside world. The parents overprotectiveness communicate a lack of confidence in the child’s ability to cope, thus reinforcing the child’s feelings of inadequacy. Indifferent or detached parents or rejecting parents also foster anxiety.

Treatment: psychopharmacological treatments are becoming more common. Behaviour therapy procedures often help anxious children, including assertiveness training to provide help with mastering essential competencies and desensitization to reduce anxious behaviour. And cognitive behavioural therapy has been shown to be highly effective at reducing anxiety symptoms.

15
Q

Describe childhood depression and bipolar disorder

A

Childhood depression includes behaviours such as withdrawal, crying, avoidance of eye contact, physical complaints, poor appetite, and even aggressive behaviour and in some cases suicide. Classified according to essentially the same DSM diagnostic criteria used for adults, however there are clear differences in hormonal levels and in the response to treatment. One modification used for diagnosing depression in children is that irritability is often found as a major symptom and can be substituted for depressed mood.

16
Q

What are causal factors in childhood depression?

A

Biological: there appears to be an association between parental depression and behavioural and dude problems in children. And the suicide attempt rate has also been shown to be higher for children of depressed parents. Depression is also related to biological changes in the neonate as a result of alcohol intake by the mother during pregnancy.

Learning factors: learning maladaptive behaviours appears to be important in childhood depressive disorders, and they’re likely to be learning or cultural factors in the expression of depression. Children’s exposure to early dramatic events can increase the risk for the development of depression and children who have experienced past stressful events are susceptible to states of depression that make them vulnerable to suicidal thinking under stress.
More common in divorced families.
Depressed mood in mothers is also associated – mothers do not respond effectively to their children and tend to be less sensitivity a tutu, and more negative toward their infants. Mothers have more unresponsive facial expressions and irritable behaviour and can produce similar responses in the infant. Depression and fathers has also been related.

17
Q

Describe treatments and outcomes for depression in children

A

Research on the effectiveness of antidepressant medications with children is both limited and contradictory. Antidepressant medications may also have undesirable side effects such as nausea, headaches, nervousness, insomnia, and even seizures. May be associated with an increased risk of suicide.
Fluoxetine may be effective.

Psychological therapy should provide a supportive emotional environment in which children can learn more adaptive coping strategies and more effective emotional expression. Older children and adolescents often benefit from a positive therapeutic relationship in which they can discuss their feelings openly. Younger children and those with less developed a verbal skills may benefit from play therapy.

18
Q

Bedwetting; involuntary discharge of urine after the age of expected continence (age 5)

A

Enuresis

Children who have primary functional enuresis have never been continent; children who have secondary functional enuresis have been continent for at least a year but have regressed.

19
Q

Disorder in children who have not learned appropriate toileting for bowel movements after age 4.

A

Encopresis

20
Q

Disorder of childhood that involves repeated episodes of leaving the bed and walking around without being conscious of the experience or remembering it later.

A

Sleepwalking or somnambulism

21
Q

Persistent, intermittent muscle twitch or spasm, usually limited to a localized muscle group, often of the facial muscles

A

Tic

22
Q

Extreme tic disorder involving uncontrollable multiple motor and vocal patterns.

A

Tourette’s disorder

Some, possibly most, tics are preceded by an urge or sensation that seems to be relieved by execution of the tic. Often referred to as compulsive tics.

23
Q

A complex vocal tic that involves the ordering of obscenities

A

Coprolalia

24
Q

Severely disabling conditions marked by deficits in language, perceptual, and motor development; defective reality testing; and inability to function in social situations. (Children)

A

Pervasive developmental disorder’s or PDD’s.

Most difficult to understand and treat. Considered to be the result of some structural differences in the brain that are usually evidence at birth or become a parent as a child begins to develop. Examples are autism and Asperger’s disorder

25
Q

Pervasive developmental disorder beginning in infancy and involving a wide range of problematic behaviors, including deficits in language, perception, and motor development; defective reality testing; and social withdrawal

A

Autism

26
Q

Parrot-like repetition of a few words or phrases

A

Echolalia

27
Q

Describe the clinical picture in autistic disorder

A

A cardinal and typical sign is that a child seems apart or aloof from others, even in the earliest stages of life.

A social deficit: do not show any need for affection or contact with anyone, and they usually do not even seem to know or care who their parents are.
Characterized as a lack of social understanding – a deficit in the ability to attend to social cues from others. The child is thought to have a “mind blindness”, and inability to take the attitude of others or to see things as others do.

Absence of speech: do not effectively learn by imitation which might explain their characteristic absence or severely limited use of speech. If speech is present, it is almost never used to communicate except in the most rudimentary fashion such as by saying yes in answer to a question or by the use of echolalia, the parrot like repetition of a few words.

Self-stimulation: usually takes the form of such repetitive movements as headbanging, spinning, and rocking, which may continue by the hour. Seem to actively arrange the environment on their own terms in an effort to exclude or limited variety and intervention from other people, preferring instead a limited and solitary routine. Often show an active abrasion to auditory stimuli, crying even at the sound of a parents voice.

Intellectual ability: show marked impairment on cognitive or intellectual tasks. Significantly impaired on memory tasks, representing mental states. Some are quite skilled at fitting objects together.

Maintaining sameness: become preoccupied with and form strong attachments to unusual objects such as rocks, light switches, or keys. When their preoccupation with the object is disturbed or when anything familiar in the environment is altered even slightly, these children may have a violent temper tantrum or a crying spell that continues until the familiar situation is restored. Often said to be obsessed with the maintenance of sameness

28
Q

Describe treatment and outcomes of autism

A

Medical treatment: in the past, the use of medications has not proved effective. Most often antidepressants, antipsychotic, and stimulants are used. The drug clomipramine has had some beneficial effects.

Behavioural treatment: in an institutional setting has been used successfully in the illumination of self injurious behavior, the mastery of fundamentals of social behavior, and the development of some language skills. A treatment developed by Lovaas is very intensive and is usually conducted in the children’s home, where the children are usually immersed in a one to one teaching situation for most of their waking hours over several years and is based on both discrimination training strategies or reinforcement, and contingent aversive techniques, or punishment.

The prognosis, especially for children showing symptoms before the age of two, is poor. Children with autism have difficulty in generalizing behaviour outside the treatment context.

29
Q

Severe and sustained a childhood impairment in social relationships and peculiar behaviours but without the language delays seen in autism.

A

Asperger’s disorder

Often referred to as an autistic spectrum disorder. Usually appears later than other pervasive development disorder such as autism.

Behaviour is often viewed as odd or a centric, including nonverbal learning disability, striving to maintain saying is, physical awkwardness, problems with language and social skills, and emotional instability. The essential features involve both severe and sustained impairment of interpersonal interactions, including impairment of facial expressions, body postures, and gestures.

In general, the outcomes are better than for those with autism.

30
Q

A set of disorders that reflects deficits in academic performance

A

Learning disorders

31
Q

Impairment of the ability to read

A

Dyslexia

The individual manifests problems in word recognition and reading comprehension; often is markedly deficient in spelling and memory. On assessments of reading skill, these persons routinely omit, and, and distort words, and their reading is typically painfully slow.

32
Q

Significantly subaverage general intellectual functioning that is accompanied by significant limitations in adaptive functioning and is obvious during the developmental period

A

Mental retardation

Mild mental retardation: the largest of those diagnosed with mental retardation. Considered educable, and their intellectual levels as adults are comparable to those of average 8 to 11-year-old children. The social adjustment Austin approximates that of adolescents, although they tend to like normal adolescents imagination, inventiveness, and judgment. Often do not show signs of brain pathology or other physical anomalies, but often require some measure of supervision because of their limited abilities to foresee the consequences of their actions. Many can become self-supporting citizens with assistance and early diagnosis.

Moderate mental retardation: likely to fall in the educational category of trainable, which means that they are presumed able to master certain routine skills such as cooking or minor janitorial work if provided specialized instruction in these activities. Intellectual levels similar to those of average 4 to 7-year-old children. Rate of learning is slow, and their level of conceptualizing is extremely limited. Usually appear clumsy and ungainly, and they suffer from bodily deformities and poor motor coordination. Most can achieve partial independence in daily self-care, acceptable behavior, and economic sustenance in a family or other sheltered environment.

Severe: motor and speech development are severely retarded and sensory defects and motor handicaps are common. Can develop Limited levels of personal hygiene and self help skills, which somewhat lessen their dependency but they’re always dependent on others for care.

Profound: severely deficient in adaptive behaviour and unable to master any but the simplest tasks. You slow speech if it develops at all, is rudimentary. Severe physical deformities, central nervous system pathology, and retarded growth are typical; convulsive seizures, mutism, deafness, and other physical anomalies are also common. Must remain in custodial care all their lives. Often have poor health and low resistance to disease and thus a short life expectancy.

33
Q

Form of moderate to severe mental retardation associated with a chromosomal abnormality and typically accompanied by characteristic physical features

A

Down syndrome

The eyes appear almond shaped, and the skin of the eyelids tend to be abnormally thick. The face and nose are often flat and broad, as is the back of the head. The tongue, which seems too large for the mouth, may show deep fissures. The iris of the eye is frequently speckled, the neck is often short and broad, as are the hands. The fingers are stubby, and the little finger is often more noticeably curved.

Associated with health problems in later life such as pneumonia and other respiratory infections. Appear to experience an accelerated ageing process and a decline in cognitive abilities. Usually able to learn self help skills, acceptable social behavior, and routine manual skills that enable them to be of assistance in a family or institutional setting. Are at extremely high risk for Alzheimer’s disease as they get into and beyond their late 30s.

34
Q

Type of mental retardation resulting from a baby’s lack of a liver enzyme needed to break down phenylalanine, an amino acid found in many foods

A

Phenylketonuria PKU

35
Q

Rare type of mental retardation characterized by an increase in the size and weight of the brain, enlargement of the skull, visual impairment, convulsions, and other neurological symptoms resulting from abnormal growth of glial cells that form the supporting structure for brain tissue

A

Macrocephaly

36
Q

Type of mental retardation resulting from impaired development of the brain and a consequent failure of the cranium to attain normal size

A

Microcephaly

37
Q

Relatively rare condition in which the accumulation of an abnormal amount of cerebrospinal fluid within the cranium causes damage to the brain tissues and enlargement of the skull

A

Hydrocephaly

38
Q

Placement of mentally retarded children in regular school classrooms for all or part of the day

A

Mainstreaming

39
Q

Field of psychology that focusses on determining what is abnormal at any point in the developmental process by comparing and contrasting it with normal and expected changes that occur

A

Developmental psychopathology