Abnormal Psych Exam 3 PDF

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Disorders of Childhood and Adolescence ● On Disorders in Childhood and Adolescence ○ Historical development in the study and treatment of child psychopathology ■ Conceptions of child psychopathology prior to the DSM ● Fairly new - less than 100 years ■ Classifying child psychopathology in the DSM ● Child schizophrenia ● Adjustment reaction of childhood ● Kept adding disorders for childhood and adolescence ■ Federal guidelines in treatment of children with special needs ● Individuals with disabilities education act (IDEA) ○ Federal legislation (modernization of old act) ○ Every child in the US gets an appropriate, free public educations regardless of any disability that they may have ○ Individualized educational programs (IEP) ■ Specifies any special needs of the child ■ Assures that each child in mainstreamed (least restrictive environment possible) ○ Ensures that parent have a role to play; they are allowed and encouraged to participate in the development of child’s education ○ Who does this protect ■ Intellectual disability, learning disorder, ADHD, autism spectrum disorder, emotional problem, speech issue ○ Recent changes in classifying disorders of childhood and adolescence (p. 75) ■ Creation of new categories ● Neurodevelopmental disorders ● Anxiety Disorders ● Depressive Disorders ● Disruptive, Impulse-Control, and Conduct Disorders ○ Antisocial Personality Disorder (in personality disorders as well) ● Elimination Disorders ○ Enuresis ● Sleep Disorders -> Sleep-Wake Disorders ○ Non-rapid eye movement sleep arousal disorder ● Anxiety in Children and Adolescents ○ On anxiety in children and adolescents ■ Can get diagnosis of disorders in the category of anxiety disorders

■ Anxiety disorder is one of the most common for childhood and adolescence ■ More common in girls than boys ○ Etiology ■ Behavioral inhibition: inheriting a particular predisposition ■ Environmental factors: early illness, hospitalization, abuse, overly anxious and protective parents, indifferent or detached parents ○ Separation Anxiety Disorder ■ Changes with the DSM-5 ● Moved to Anxiety Disorder ● Had to have onset in developmental years (before 18) but in DSM onset can come at any time ○ Still commonly seen onset before 18 ■ Diagnostic criteria ● Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by three of the following ○ Recurrent excessive distress when separated from home ○ Persistent and excessive worry about losing major attachment figures ○ Persistent and excessive worry that an event will lead to separation from one ○ A major attachment figures ○ Persistent reluctance or refusal to go away from home (e.g. to school, to work) ○ Persistent reluctance or refusal to go to sleep alone ○ Repeated nightmares involving the theme of separation ○ Repeated complaints of physical symptoms when anticipating or following separation from major attachment figures ● The duration of the disturbance is at least 4 weeks in children and adolescents and 6 months in adults ● The disturbance causes clinically significant distress or impairment in functioning ■ Demographics ● More common in girls ● More expressive in children from very close-knit families ● Can begin as early as preschool ○ May be difficult to differentiate between normal separation anxiety ● Symptoms wax and wain

■ Separation Anxiety Disorder vs normal separation anxiety in children ● Not an extension of normal separation anxiety ● First year or two of life separation anxiety is health ○ School Phobia ■ Used to be defined as an unrealistic fear that keeps children away froms school ■ Now, defined as the fear of leaving one’s parents, not the fear of school itself ■ Considered a possible symptom of Separation Anxiety Disorder ● Normally stay at home and not at school ● Not that they are bad students or truant, normally have high grades ● Parents tend to be professionals ● Do not want to make established pattern of behavior ■ Treatment ● Parents work in the classroom, help teacher ● Then slowly move further away ● Depression in Children and Adolescents ○ Multiple uses of the term depression ■ Period of the blues ● Got bad grade, didn’t get invited to birthday party ■ Symptoms of depression ● Not full-blown depressive disorder ● Difficulty sleeping, loss of appetite, difficulty concentrating ■ Full-blown case of depression ● Major Depressive Disorder ○ Allows a child to express sadness as irritability in the criteria ○ Can be diagnosed in children and adults ○ More common in females than males ● Persistent Depressive Disorder (Dysthymia) ○ For child only need to persist for a year ○ Can be diagnosed in children and adults ● Disruptive Mood Dysregulation Disorder ○ Was not in DSM-4 ○ More in boys than girls ○ Onset prior to the age of 10 ○ Chronically irritable, temper tantrums, angry ○ Prevalence ■ 17% lifetime prevalence rate ■ More common in females than males starting in adolescence ■ Typical age of onset in 20s

■ Not uncommon for children and adolescence to experience some symptoms of depression ○ Etiology ■ Genetic predisposition ■ Lots of environmental factors ● Traumatic event, parents get divorce, abuse, parent is depressed ○ Treatment ■ Similar to treatment of adults ■ More research needed ■ Need to know Long-term effects of antidepressants ■ Parents need to provide supportive environment (family therapy) ■ Cognitive therapy ■ Play therapy if dealing with a young child ● Disorders Associated with Defiance and Aggression ○ Overview ■ Diagnosed in individual engaging in defiant and aggressive behavior ■ Emotional disturbance ■ ODD -> CD -> APD (onset and severity) ■ Mostly seen in boys, more common in males than females ○ Oppositional Defiant Disorder (ODD) ■ First symptoms usually evident during preschool years and rarely later than early adolescence ■ Involves a pattern of hostile and defiant behavior that is usually limited to the home ■ Includes loss of temper, arguing, refusal of requests, anger, resentfulness, and deliberate annoyance of others ■ “Trouble-maker” at home, youngest onset ■ Gradually develops over time (months, years) ■ Sometimes develops into a Conduct Disorder ○ Conduct Disorder (CD) ■ Usually emerges in middle childhood through middle adolescence ■ Involves a pattern of conduct in which societal norms and the basic rights of others are violated over the course of the past year in a variety of settings (e.g. in the home, at school, with peers) ■ Includes stealing, lying, running away from home, school truancy, fighting, destruction of others’ property, fire setting, and cruelty of animals ■ Typically preceded developmentally by Oppositional Defiant Disorder ■ May develop into Antisocial Personality Disorder typically if onset is in early childhood ● If onset is in adolescence it will most likely not develop into antisocial personality disorder

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■ More serious disorder than ODD ■ More common in urban areas than rural areas, prevalence has increased over time Conduct Disorder and Juvenile Delinquency ■ Diagnosis/psychiatric disorder vs legal construct ■ Illegal behavior by a minor Antisocial Personality Disorder ■ Not diagnosed until 18 years of age ■ Involves pattern of disregard for and violation of the rights of others ■ Includes irritability, aggressiveness, stealing and harassing others, deceitfulness, recklessness, irresponsibility and lack of remorse ■ Typically preceded developmentally by Conduct Disorder ■ Qualitatively more serious than CD Antisocial Personality Disorder and Psychopathy ■ Antisocial Personality Disorder was not introduced until 1980s in the DSM 3 ■ Although antisocial personality disorder is not identical, the pattern of behavior is similar to those of psychopathy and sociopathy ■ Is no diagnosis to psychopathy and sociopathy only antisocial personality disorder Antisocial Personality Disorder and Criminal Behavior ■ Antisocial personality disorder is psychological or psychiatric construct while criminal behavior is a legal construct ■ Can be diagnosed with antisocial personality disorder and not express criminal behavior ■ There is high prevalence of the relationship Relationships between ODD, CD, and Antisocial Personality Disorder ■ Rough relationship between these disorder is increasing age and increasing seriousness ■ ODD can go away or turn into CD ■ If child onset of CD, tends to be more serious and more likely to develop antisocial personality disorder ■ Onset in adolescence of CD will most likely not turn into antisocial personality disorder Causal factors of ODD and CD ■ Possible genetic factor, temperamental style ● Greater risk ■ Psychosocial factors ● Parenting style (authoritarian, permissive) ● Stress in family dynamic ● Abuse

● Bullying at school and poor peer relationships ● Poor socioeconomic status ○ Treatment of ODD and CD ■ Family therapy is most common treatment ● Teach mom and dad more authoritative parenting skills ● Teach mom and dad behavior therapy techniques (reinforcement) ● Help mom and dad to modify environment ○ More structure/schedule ● Sleep Disorders in Children and Adolescents ○ Normal sleeping patterns in childhood ■ Young children sleep deeply through the night ■ Traditionally, suggested that kids should take a nap until 5 years old, but has changed to not take a nap when 3-5 ● Rest time instead, quiet time ■ More resistant to going to bed as kids turn 5 years old ● Elaborate bedtime routines: usually effective ● Transitional objects: teddy bear, blanket ○ Should not worry if child has transitional object as they get older ○ Sleep patterns across the lifespan ■ Sleep patterns vary ■ Tend to need less sleep as we get older ● Newborns need about 18 hours of sleep a night ○ Wake up every 2-3 hours ● 3 months start to sleep through night (6-7 hours) ● 6 months will do more than half of sleeping at night ● Early Childhood (3-6 years old) need about 11 hours of sleep ● Middle Childhood (6-11 years old) need about 10 hours of sleep ● Adolescents need about 9 hours ● Adults need about 7 to 8 hours ● 65+ don’t need as much sleep, 6 to 7 hours of sleep ■ Sleep cycle ● Stage 1: light sleep ● Stage 2 ● Stage 3 ● Stage 4: deep sleep (delta waves), longest in first sleep cycle ● Then go back to stage 3, stage 2 ● REM sleep: shortest in first sleep cycle ○ Classifying sleep disturbances in the DSM-5 ■ Sleep-Wake Disorders

● Isolated or infrequent episodes of nightmares, night terrors, or sleepwalking are relatively common in the general population ● These sleep related events are only classified as a disorder if they are recurrent and are accompanied by either distress or impaired functioning ● They are classified in a category called Sleep-Wake Disorder under Parasomnias ● Parasomnias are disorders characterized by abnormal events occurring in association with sleep and/or specific sleep stages ● Individuals who experience abnormal sleep episodes involving night terrors or sleepwalking are both diagnosed with Non-Rapid Eye Movement (NREM) Sleep Arousal Disorder ○ Sleep disturbances ■ Nightmares ● Frightening dreams during REM sleep ● Can happen for any number of reasons ● Most typical dreams are going to occur during REM sleep (2nd half of sleep is likely) ● Psychological disorder if it is recurrent and if it causes significant distress and/or disfunction ■ Night terrors ● Abrupt awakening during Stage 4 sleep which begins with a panicky scream or cry and typically lasts 1-10 minutes ● Not fully awake, after night terror will return to normal sleep ● Will not remember night terror in the morning ● Do not know why some children have them and why some don’t ● Will normally go away on their own after childhood ● More common in boys ● Tends to run in families ● Psychological disorder if it is recurrent and if it causes significant distress and/or disfunction ■ Sleepwalking ● Rising from bed during Stage 4 sleep that typically lasts only a few minutes ● 10-30% of all children will have an episode of sleepwalking ● Psychological disorder if it is recurrent and if it cause significant distress and/or disfunction ● Typically goes away by adolescence ● Usually nothing exciting happens during sleepwalking ● Eyes open but not fully awake ● Can wake someone up gently and carefully as to not scare them

● Will not remember sleepwalking in morning unless woken up during the event ● More common in girls than boys in childhood ● Runs in families ○ Nightmare Disorder vs Non-Rapid Eye Movement Sleep Arousal Disorders ■ Nightmare Disorder ● Occurs during REM sleep ● Occurs during second half of sleep ● Awakens easily ● Reports vivid dreams ■ NREM Sleep Arousal Disorders ● Occurs during Stage 4 sleep ● Occurs during first third of sleep ● Typically does not awaken fully ● Has amnesia for the episode ● Enuresis ○ On Enuresis ■ Diagnostic Criteria ● Repeated voiding of urine into bed or clothes ● The behavior is clinically significant as manifested by either a frequency of twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning ● Chronological age is at least 5 years ● The behavior is not due exclusively to the direct physiological effect of substance or a general medical condition ■ Types of Enuresis ● Primary ○ Diagnosed in a child who never established urinary continence ■ Continence: do not wet bed or pants during the day ■ Incontinence: do wet bed or pants during the day ● Secondary ○ Diagnosed in a child who has regressed after at least a year of established urinary continence ○ Etiology ■ Prevalence decreases with age ■ 5-10% of 5 year olds experience enuresis ■ Middle childhood 3-5% ■ Adolescents 1% (1% of that 1% continue to experience enuresis into adulthood)

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More common in boys than girls Run in families Can negatively impact self-esteem, not intentional May limit social activity Parents get frustrated, not realizing child cannot control behavior Strong genetic component High concordance rate for monozygotic twins Maturing more slowly than their peers May be a problem with learning - never learned to recognize the cues that bladder is full ○ Treatment ■ Sometimes medication but learning behavior is more likely to be used ■ Bell and Pad Method (classical conditioning) ● Technique developed by Mowrer using classical conditioning to treat individuals with Enuresis ● Process ○ The child sleeps on a pad wired to an alarm ○ The first drops of urine set off the alarm and wake the child ○ The child comes to associate a full bladder with awakening ● Very high success rate ● Variation are still used widely today ■ Does not always go away on its own so treatment is sometimes necessary ■ Also makes child feel bad or parents annoyed with children Neurodevelopmental Disorders ● Overview ○ Neurodevelopmental disorders new category in DSM-5 ○ Mental Retardation -> Intellectual Disability ○ Manifest early in development ○ Onset during developmental period (operationally defined as prior to age of 18) ○ All cause impairment (social, intellectual, academic) ○ All more common in males than females ● Intellectual Disability (Intellectual Developmental Disorder) ○ What is Intellectual Disability? ■ Diagnostic criteria ● Deficits in mental abilities or intellectual functioning (IQ < 70) ● Impairment in adaptive functioning for the individual’s age and sociocultural background ● All symptoms must have an onset during the developmental period (prior to age of 18)

○ Prevalence ■ 1% of population fit all three of diagnostic criteria ■ 2.5% of population fit in the criteria of an IQ < 70 ○ Gender Differences ○ Severity levels ■ Depending on IQ scores before the DSM 5 ■ DSM 5: large majority is mildly intellectually disabled (can function at about the 6th grade level of education) ● Mild ● Moderate ● Severe ● Profound ○ Etiology ■ Heredity ● Tay-Sachs Disease ○ Degenerative brain disease transferred via recessive gene ○ Very short life expectancy ○ Associated with intellectual disability ○ Most common in eastern european ancestry and jewish ancestry ○ Can get screened for it ■ Aberrations in chromosomal development (abnormality before fertilization) ● Down’s Syndrome ○ Individual has three 23rd chromosomes ○ Most common of chromosomal disorders ○ Will have some degree of intellectual disability ○ Many can function at a 6th grade level, develop language, and with support can be functional as adults ○ Eye defects, respiratory problems and heart defects are common with down’s syndrome ○ Individuals tend to has differences in appearance (shorter, stalkier, eyes slanted) ○ Slightly more likely to have child with Down’s syndrome with older parental age ■ Prenatal and pregnancy problems ● Prenatal Alcohol Exposure ○ Occurs when an expectant mother consumes alcohol, predisposing her unborn child to increased likelihood of ID and birth defects ○ Fetal Alcohol Spectrum Disorder (FASD)

■ Group of disorders caused by prenatal alcohol exposure ■ About 1 out of every 100 children are born on the spectrum ■ Fetal Alcohol Effects (FAE) represents the less serious end of the spectrum of FASD ■ Fetal Alcohol Syndrome (FAS) represents the more serious end of the spectrum of FASD ● Infants are smaller, facial/body differences and intellectual disability ● More likely to develop specific learning disorder and ADHD ● Varying degrees of severity -> FASD ○ Most common cause of intellectual disability and the leading cause of preventable birth defects ● Risk factors for intellectual disability ○ Fetal malnutrition ○ Premature birth ■ General medical conditions acquired in infancy/childhood ● Trauma ● Bacterial meningitis ● Water with lead ● Eating paint ● Car accident ■ Environmental influences ● Deprivation ● Institutionalized (lack of intellectual stimulation) ○ Treatment ■ Special Education ● Educational programs that help children with disabilities ● Can be part of the day or the whole day ■ Rehabilitative Measures ● Skill-training programs for adolescents and adults that include sheltered workshops ● Learning simple tasks to better prepare for life in the real world ■ Community-Based Programs ● Programs that aim to teach self-supporting skills, such as ClemsonLIFE ● Becoming more common ■ Institutionalization ● Last resort for disabled individuals

● Used to be more common, less common today ● Specific Learning Disorder ○ What is a Specific Learning Disorder ■ Diagnosed when the individual’s achievement on an individually administered standardized test in reading, mathematics, or written expression is substantially below that expected for their level of intelligence as measured on an individually administered aptitude test ● Usually given the Wechsler test ● Aptitude test is significantly higher than Achievement test ■ Follow up with other tests to determine if the individual has a Specific Learning Disorder ■ DSM 5 combined all learning disorders into Specific Learning Disorder ○ Three different problem areas in skill acquisition ■ Reading ● Word reading accuracy ● Reading rate or fluency ● Reading comprehension ● Dyslexia ○ Alternative term to a specific learning disorder with impairment in reading ○ Not an actual diagnosis ■ Mathematics ● Number sense (understanding what numbers mean, magnitude) ● Memorization of arithmetic facts ● Accurate or fluent calculation (making lots of mistakes) ● Accurate math reasoning (problem-solving) ● Dyscalculia ○ Alternative form for a specific learning disorder with impairment in mathematics ■ Written expression ● Spelling accuracy ● Grammar and punctuation accuracy ● Clarity or organization of written expression ● Not as common, but also not as good at testing for it ● Tends to go together with reading impairment but not necessarily ■ Depending on the child’s skill deficiency, we would add one or more of the above impairments as specifier to the diagnosis ● Can have one, two, or all ● Reading impairment is most common ○ Age of onset ■ As early as kindergarten or first grade (reading)

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2nd grade or so (math...