Chapter 17 Flashcards
(23 cards)
Childhood Anxiety Disorders
- Some level of anxiety is normal in childhood
- Children may be strongly affected by parental problems/inadequacies
- Divorce, illness, or long-term separation
- Genetic studies suggest some children are prone to anxious temperament
- 14-25% of all children and adolescents experience an anxiety disorder
- Typically dominated by behavioral and somatic symptoms rather than cognitive ones
- Separation Anxiety Disorder and Selective Mutism
Separation Anxiety Disorder
- Displayed by 4-10% of children
- Extreme anxiety/panic whenever separated from home or a parent
Selective Mutism
- Children consistently fail to speak in certain social situations, but show no difficulty at all speaking in others
- Disorder often begins as early as preschool years
- Affects ~ 1% of children
- Checklist
- Individual persistently doesn’t speak in certain social situations in which speech is expected, although speaking in other situations presents no problem
- Academic or social interference
- Individual’s symptoms last 1 month or more, and aren’t limited to first 4 weeks of new school year
- Symptoms not due to ASD, thought disorder, or language or communication disorder
Treatments for Childhood Anxiety Disorders
Despite high prevalence of childhood and adolescent anxiety disorders, 2/3 of anxious children go untreated
- Psychodynamic, cognitive-behavioral, family, and group therapies, as well as drug therapies, separately or together, have been used most often
- Most children cannot effectively sit down and express feelings verbally
- Play therapy (can be used for emotionally/mentally stunted adults)
- Children play w/ toys, draw, and make up stories
- Reveal conflicts in lives and their related feelings
Oppositional Defiant Disorder
- Children with this disorder are repeatedly argumentative and defiant, angry and irritable, and in some cases, vindictive (hold a grudge, particularly w/ adults or authority)
- Characterized by repeated arguments w/ adults, loss of temper, anger, and resentment
- Children persistently ignore adults requests/rules, try to annoy others, and blame others for mistakes/problems
- 11% of children (high incidence rate)
Conduct Disorder
- A more severe problem, children repeatedly violate others’ basic rights
- Often aggressive and may be physically cruel to people and animals
- Many steal from, threaten, or harm victims
- Begins between 7-15 (earlier onset produces later offset)
- What are the causes of conduct disorder?
- Linked to genetic and biological factors, substance use, poverty, traumatic events, and exposure to violent peers or community violence
- Cases most often tied to troubled parent-child relationships (parent may have disorder such as SAD), inadequate parenting, family conflict, and family hostility
- How do clinicians treat conduct disorder?
- Generally most effective with children younger than 13 ( >13)
- Parent management training: combination of family and cognitive-behavioral interventions to help improve family functioning and help parents deal w/ children more effectively
- Teach parents how to stop rewarding unwanted behaviors and consistently reward proper behavior - Multisystemic therapy: treat family dynamics, and also work to increase amount of time children spend with positive children and adult role models
Child-Focused Treatments
Cognititve-behavioral interventions
- Problem-solving skills training
- Modeling, practice, role-playing, and systematic rewards
- Coping Power Program
- Group sessions that teach them to manage anger more effectively, build social skills, set goals, handle peer pressure
Attention-Deficit Hyperactivity Disorder
- Children who display attention-deficit/hyperactivity disorder (ADHD) have difficult attending to tasks, behave overactively and impulsively, or both
- Approx 4-9% of school-aged children display ADHD, as many as 70% boys
- Disorder usually persists through childhood, but many children show lessening of symptoms as they move into mid-adolescence
- About 80% of all children/adolescents with ADHD recieve treatments
- About 1/2 the children w/ ADHD also have:
- Learning or communication problems
- Poor school performance
- Difficult interacting w/ other children
- Misbehavior, often serious
- Mood or anxiety problems
ADHD Checklist
Individual presents one or both of following patterns
- For 6 months or more, individual frequently displays 6+ symptoms of inattention, to a degree that is maladaptive and beyond that shown by most similarly aged person
- High rate of academic withdrawal or dropout for those with ADHD
- For 6 months or more, individual frequently displays 6+ symptoms of hyperactivity and impulsivity, to a degree that is beyond that shown by most of same age
Causes of ADHD
Clinicians generally consider it to have several interacting causes:
- Biological causes, particularly abnormal dopamine activity, and abnormalities in frontal—striatal regions of the brain
- High levels of stress
- Family dysfunction
Drug Therapy for ADHD
- Millions of children and adults with ADHD are treated w/ methylphenidate (Ritalin), a stimulant drug that has been available for decades
- Increases ability to focus, solve complex tasks, perform better at school, interact better w/ families, and control aggression
- Many clincians worry about possible long-term effects of drugs
- Others question whether favorable findings of drug studies are applicable to children from minority groups
- Stimulants can be addictive if misused
Multicultural Factors and ADHD
Studies indicated Black and Latinx American children w/ significant attention and activity problems are less likely than White American children to be assessed for ADHD, recieve a diagnosis, or undergo treatment for the disorder
- Those who recieve diagnosis are less likely than White children to be treated w/ interventions that seem to be of most help, including long-acting stimulant drugs
Behavior Therapy and Combination Approaches for ADHD
Behavioral therapy has been applied in many cases of ADHD
- Parents and teachers learn how to apply operant conditioning techniques to change behavior
- These treatments have often been helpful, especially when combined with drug therapy
Autism Spectrum Disorder (ASD)
First identified in 1943
- Marked by unresposniveness to other people, communication deficits, and highly rigid/repetitive behaviors, interests, and activities
- Symptoms appear early, typically before age 3
- Increase in # of children diagnosed
- Now about 1 in 60
Diagnostic Criteria of ASD
-Individual displays continual deficiencies in various areas of communication and social interaction, including the following:
- Social-emotional reciprocity
- Nonverbal communication
- Development and maintenance of relationships
- Individual displays significant restriction and repetition in behaviors, interests, or activities, including two or more of the following:
- Exaggerated and repeated speech patterns, movements, or object use
- Inflexible demand for same routines, statements, and behaviors
- Highly restricted, fixated, and overly intense interests
- Individual develops symptoms by early childhood
- Individual experiences impaired functioning
Information about ASD
- Lack of responsiveness and social reciprocity
- Language and communication problems that take various forms
- 1/3 don’t say more than a few words; 50% develop “useful speech”
- Echolalia: the exact echoing of phrases spoken by others
- Pronoun reversal
- The motor movements of autistic individuals may be unusual
- Often called “self-stimulatory” behaviors; may include jumping, arm flapping, and making faces
- Wide variation in severity and outcome of disorder
- Children who have IQ above 50 and communicative speech before 6 have better prognosis than others
- Early prognosis means it is likely more severe
- Out of 68 individuals diagnosed w/ autism as children and who had performance (nonverbal) IQ of at least 50:
- 5 go to college, 2 obtain postgrad degree
- Majority required ongoing support from parents or some form of residential care
- Children who have IQ above 50 and communicative speech before 6 have better prognosis than others
Causes of ASD
Sociocultural causes
- Some clinical theorists proposed high degree of family dysfunction, social stress, and environmental stress are key factors
- Research doesn’t support this theory
Psychological causes
- Some theorists say autistic individuals have a central perceptual or cognitive disturbance
- Individual may fail to develop a theory of mind — an awareness that other people base behaviors on own beliefs, intentions, and other mental states
- Autistic people may also display deficiencies in joint attention, sharing focus with others
Biological causes
- A detailed biological explanation for ASD hasn’t been developed, but promising leads have been uncovered
- NOT MMR vaccine
- Examination of relative suggests genetic factor in disorder
- Prevalence rates higher among siblings, highest among MZ twins
- Prenatal difficulties or birth complications
- Researchers identified specific biological abnormalities that may contribute to the disorder, particularly in cerebellum
How Clinicians and Educators Treat ASD
Cognitive-behavioral therapy
- Behavioral approaches used to teach new appropriate behaviors — including speech, social skills, classroom skills, and self-help skills — while reducing negative behaviors
- Most often, therapists use modeling and operant conditioning
- Therapies ideally applied when started early in child’s life
Drug therapy
- Selective serotonin reuptake inhibitors — reduce repetitive behaviors & aggression
- Atypical antipsychotic medications — reduce obsessive and repetitve behaviors and improve self-control
- Stimulants — used to improve attention
Communication training
- May be taught other forms of communication, including sign language and simultaneous communication
- Some may use augmentative communication systems, such as “communication boards” or computers that use pictures, symbols, or written words, to represent objects or needs
Parent training
- Today’s treatment programs involve parents in variety of ways
- Behavioral programs train parents so they can apply behavioral techniques at home
- Individual therapy and support groups are becoming more available to help parents deal with own emotions and needs
Intellectual Disability
According to DSM-5, people should receive a diagnosis when they display general intellectual functioning well below average, in combo w/ poor adaptive behavior
- IQ must be 70 or lower
- Person must have difficult in such areas as communication, home living, self-direction, work, or safety
- Symptoms must appear before 18
What are the Features of an Intellectual Disability?
- The most consistent sign of intellectual disability is that person learns very slowly
- Other areas of difficulty: attention, short-term memory, planning, and language
- Those institutionalized w/ disability are likely to have these limitations
Mild Intellectual Disability (ID)
- Approx 80-85% of all w/ disability fall into this category (IQ 50-70)
- Research has linked mild ID mainly to sociocultural and psychological causes
- Poor/unstimulating environments
- Inadequate parent-child interactions
- Insufficient early learning experiences
- At least some biological factors also may be operating
- Moderate drinking, drug use, or malnutrition during pregnacy
Causes of an Intellectual Disability
Unlike mild ID, main causes of moderate, severe, and profound ID are biological
- Chromosomal causes
- Down syndrome: most common chromosomal disorder leading to ID
- Fewer than 1 in 700 live births, rate increases greatly when mother is over 35
- Several types of chromosomal abnormalities may cause Down syndrome, most common is trisomy 21
- Fragile X syndrome: second most common chromosomal cause of ID
- Down syndrome: most common chromosomal disorder leading to ID
- Metabolic causes
- In metabolic disorders, body’s breakdown or production of chemicals is disturbed
- Examples:
- Phenylketonuria (PKU)
- Tay-Sachs disease
- Prenatal and birth-related causes
- Major physical problems in pregnant mother can threaten healthy fetus development
- Alcohol use may lead to fetal alcohol syndrome (FAS)
- Certain maternal infections during pregnancy (e.g. rubella, syphilis) may cause childhood problems including ID
- Birth complications, such as a prolonged period w/o oxygen (anoxia), can lead to ID
- Major physical problems in pregnant mother can threaten healthy fetus development
- Childhood problems
- After birth, particularly up to age 6, certain injuries and accidents can affect intellectual functioning
- Poisoning
- Serious head injury
- Excessive exposure to X rays
- Excessive use of certain chemicals, minerals, and/or drugs (e.g. lead paint)
- Certain infections, such as meningitis and encephalitis, can lead to ID if they aren’t diagnosed and treated in time
- After birth, particularly up to age 6, certain injuries and accidents can affect intellectual functioning
Intervention for People w/ ID
- The quality of life attained by people w/ ID depends largely on sociocultural factors
- Intervention programs work to provide comfortable and stimulating residences, social and economic opportunities, and a proper education
- Socializing, sex, and marriage are difficult issues for people with ID and their families
- Intervention programs work to provide comfortable and stimulating residences, social and economic opportunities, and a proper education
