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Flashcards in developmental psych Deck (64):
1

ADHD associated with what deficit ??
A. decreased cranial rhythmic impulse
B. fascialstrainofthe diaphragma sellae
C. hyperactivity of the periaqueductal gray area
D. hypoactivity of the dorsolateral prefrontal cortex
E. shearofthetentorium cerebelli

C. hypoactivity of the dorsolateral prefrontal cortex

2

During which one of Piaget’s stages of development will a child be able to understand that a tall glass and short wide glass contain the same volume of water despite their different shapes?
A. Sensorimotor stage
B. Preoperationalthoughtstage C. Concrete operations stage D. Formal thought stage
E. Analstage

C. Concrete operations stage

3

Which one of the following symptoms would a psychiatrist look for in a child to make the diagnosis of conduct disorder rather than depression, ADHD or bipolar disorder?
A. irritable mood
B. difficultiesorganizingtasks
C. excessive activity
D. starting fights with other children
E. sleepdisturbance

D. starting fights with other children

4

A couple brings their son in to see a psychiatrist. The child fights with his mother and father and is rude and dismissive toward them. He states that he wants to leave, and when the doctor tell shim he has to stay he yells, curses, cries, and rolls around the floor. His teacher tells the psychiatrist that his work at school is good, but that he gets very nasty with her when she tells him to do a particular task, and he often refuses to cooperate with her. The child’s most likely diagnosis is?
A. ADHD
B. Bipolar Disorder
C. Conduct Disorder
D. Oppositional Defiant Disorder
E. SeparationAnxietyDisorder

D. Oppositional Defiant Disorder

5

A 15-year-old male has stolen automobiles, has been truant from school, and has had frequent fights with other teenagers for the past year. This patient meets criteria for which of the following DSM- 5 disorders?
A. adjustment disorder with disturbance of conduct
B. antisocialpersonalitydisorder
C. attention deficit hyperactivity
disorder
D. conduct disorder
E. oppositionaldefiantdisorder

D. conduct disorder

6


A. Normal development
B. Earlyonsetpuberty
C. Traumatic brain injury
D. Sexual abuse
E. Psychosiswithsexual delusions

D. sexual abuse

7

birth-2yrs (infancy)

Freud: oral stage
Erikson: trust vs. mistrust
Piaget: sensorimotor period
Kohlberg: no moral development

8

1.5-3 years (toddler)

Freud: anal stage
Erikson: autonomy vs. shame/doubt
Piaget: preconceptual
Kohlberg: no moral development

9

3-6 yrs (early childhood)

Freud: Phallic
Erikson: initiative vs. guilt
Piaget: preoperational
Kohlberg: preconventional

10

7-11 yrs (mid childhood)

Freud: latency
Erikson: industry vs. inferiority
Piaget: concrete operations
Kohlberg: conventional

11

12-18 yrs (adolescence)

genital stage
identity vs role confusion
formal operations
postconventional

12

18-40 yrs (adulthood)

genital stage continues
intimacy vs isolation

13

40-65 yrs (middle yrs)

generativity vs. stagnation

14

65+ (late adulthood)

integrity vs. despair

15

Piaget’s Cognitive Developmental

Sensorimotor(0-2)
Pre-operational (2-7)
Concrete Operational (7-11)
Formal Operational (11-15)

16

Sensorimotor Stage (Birth – 2)

*Object permanence 8–9months* (means knowing that an object still exists, even if it is hidden. It requires the ability to form a mental representation (i.e. a schema) of the object.)

Rapid cognitive growth
Most action is reflexive
Perception of events are centered on the body
Objects are an extension of self, extreme egocentrism Trial and error learning

17

Social Smile/Cooing ??
Stranger anxiety ??
transitional objects?
Rapprochement

about 2 months
6-8 mos, separation anxiety begins here as well
6-18 mos
15-24 mos

18

separation anxiety begins ?? ends when ??

6-8 mos
ends around 2 yrs
*Object Constancy : 2-3 years*

19

Pre-operational Stage (2-7)

increase in pretend play
still egocentric
-symbolic function substage: able to understand, represent, remember, and picture objects in their mind without having the object in front of them.
-intuitive thought substage: tend to propose the questions of "why?" and "how come?" This stage is when children want the knowledge of knowing everything

20

Concrete operational stage (7-11)

appropriate use of logic
◦ Elimination of egocentrism
◦ thought processes become more mature
◦ They start solving problems in a more logical fashion.
◦ Abstract, hypothetical thinking is not yet developed in the child ◦ *Conservation*
-Child understands that death is irreversible at around age 7

21

Formal operational stage (11-15)

Abstract thoughts Problem solving

22

Erikon’s Psychosocial Stages

◦ Trust vs Mistrust (Birth-2)
◦ Autonomy vs Shame and Doubt (1 1⁄2 - 3)
◦ Initiative vs Guilt (3-6)
◦ Industry vs Inferiority (7-11) (competency)
◦ Identity vs Role Confusion (12-18
◦ Intimacy vs Isolation (18-40)
◦ Generativity and Stagnation (40-65)
◦ Integrity vs. Despair (>65)

23

Freudian Psychosexual Stages
Personality and Iceberg Theory

Id : unconscious urges to obtain pleasure
Ego: mediates the demands of the id, the superego and reality.
Superego : how to behave based on learned morals and values.

24

Freudian Psychosexual Stages

Oral Stage (Birth – 1 1⁄2) ◦ Anal Stage (1 1⁄2 - 3)
Phallic Stage (3-6)(Gender Identity : Age 3)
Latency (7-11)
Genital Stage (12-18)
Adulthood (>18): Freud believed that the genital stage lasts throughout adulthood. He also said that the goal of healthy life is “to love and to work well”.

25

Separation Anxiety Disorder:
Developmentally inappropriate/excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least THREE of the following:

1) excessive DISTRESS when anticipating or experiencing separation from home or "mom"
2) excessive worry about LOSING "mom" or about possible harm to them
3)Persistent and excessive WORRY about experiencing an untoward event
4)Persistent reluctance or REFUSAL TO GO OUT, away from home, to school, to work, or elsewhere because of fear of separation.
5)Persistent and excessive FEAR of or reluctance about being alone or without "mom" at home or in other settings.
6)Persistent reluctance or REFUSAL TO SLEEP away from home or to go to sleep without being near "mom"
7)Repeated NIGHTMARES involving the theme of separation.
8)Repeated COMPLAINTS of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from "mom" occurs or is anticipated.

26

Separation Anxiety Disorder timeline

The fear, anxiety, or avoidance is persistent, lasting *AT LEAST 4 WEEKS* in children and adolescents and typically 6 MONTHS OR MORE IN ADULTS
The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning

27

Attachment Theory

Dr. John Bowlby: British Psychiatrist
◦ Secure Attachment
◦ Insecure Attachment
◦ Avoidant Attachment
◦ Resistant/Ambivalent Attachment
◦ Disorganized Attachment

28

Reactive Attachment Disorder A.

A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
-The child rarely or minimally seeks comfort when distressed
-The child rarely or minimally responds to comfort when distressed.

29

Reactive Attachment Disorder B.

B. A persistent social and emotional disturbance characterized by at least two of the following:
-Minimal social and emotional responsiveness to others.
-Limited positive affect
-Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.

30

Reactive Attachment Disorder C.

The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
-Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by care giving adults.
-Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
-Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).
(these criterion cause behavior in criteria A)

31

Reactive Attachement disorder timeline

disturbance is evident before age 5 years.
The child has a developmental age of at least 9 months.

32

Autism Spectrum Disorder dx acronyms

ADOS - Autism Diagnostic Observation Schedule
ADI-R - Autism Diagnostic Interview, Revised
M-CHAT - Modified Checklist for Autism in Toddlers
CARS - Childhood Autism Rating Scale

33

Autism Spectrum Disorder risk factors

Identical twins: the other affected 36-95% of the time.
Non-identical twins: the other is affected about 0-31% of the time.
Parents who have a child with ASD: 2%–18% chance with second child
-more often in certain genetic or chromosomal conditions: About 10% of children with autism are also identified as having Down syndrome, fragile X syndrome, tuberous sclerosis, etc.
-Children born to older parents are at a higher risk for having ASD.
-A small percentage of children who are born prematurely or with low birth weight are at greater risk for having ASD

34

ASD prevalence

-1 in 68 children has been identified with ASD)according to estimates from CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network.
-occurs in all racial, ethnic, and socioeconomic groups
- almost 5 times more common among boys (1 in 42) than among girls (1 in 189).

35

ASD dx criteria: A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:

-Deficits in social-emotional reciprocity
-Deficits in nonverbal communicative behaviors used for social interaction
-Deficits in developing, maintaining, and understanding relationship

36

ASD dx criteria: B. Restricted, repetitive patterns of behavior, interests, or activities, at least two:

-Stereotype/repetitive motor movements, use of objects, or speech: Insistence on sameness, inflexible adherence to routines, or ritualized patterns
-Highly restricted, fixated interests that are abnormal in intensity or focus
-Hyper- or hyporeactivity to sensory input

37

ASD levels

◦ Level 3 “Requiring very substantial support” ◦ Level 2 “Requiring substantial support”
◦ Level 1 “Requiring support”

38

ASD tx

Therapy: Floortime, ABA (Applied Behavioral Analysis)
◦ If speech/motor skill delay: speech therapy, occupational therapy, physical therapy
◦ Early intervention/treatment can lead to better prognosis
*No medications for treating the ASD behaviors*

39

ASD tx: CAN tx comorbid symptoms

Irritability, aggression : FDA approved: risperidone (Risperdal) and aripiprazole (Abilify)
Anxiety: SSRIs (Prozac, Zoloft)
ADHD: stimulants/non-stimulants (Ritalin, Adderall/Strattera)

40

ADHD epi

4-8% of children
◦ 4:1 : male : female – hyperactive
◦ 2:1 : male : female - inattentive
-2/3 have co-morbid psychiatric disorders:
◦ 30-40% CD or ODD (genetic connection)
◦ 15-20% mood disorders
◦ 20-25% anxiety disorders
◦ 25-30% substance disorders
(treatment: stimulants-lessens substance use not worsens)

41

ADHD pathophys

-structural imaging: slightly smaller right prefrontal cortex, caudate nucleus, globus pallid us
-functional imaging: (fMRI, PET, SPECT) suggest lower basal activity in *prefrontal cortex and striatum* – areas high sensitive to catecholamine input - NE and DA

42

ADHD DSM-5:

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by Inattention or Hyperactivity, impulsivity

43

ADHD: Six (or more) of the following symptoms have persisted for at least *6 months*
(5 symps For older adolescents and adults (age 17 and older))
1. Inattention

-careless mistakes, lack of attention to detail
-difficulting keeping attention in tasks/play
-doesn't seem to listen when spoken to directly
-does not follow thru on instructions and fails to finish tasks
-difficulting organizing tasks
-avoids/dislikes tasks that require sustained mental effort
-loses things necessary for tasks
-easily distracted by outside stimulus

44

ADHD: 2. Hyperactivity and impulsivity:

◦ Often fidgets with or taps hands or feet or squirms in seat
◦ Often leaves seat in situations when remaining seated is expected
◦ Often runs about or climbs in situations where it is inappropriate
◦ Often unable to play or engage in leisure activities quietly
◦ Is often “on the go,” acting as if “driven by a motor”
◦ Often talks excessively
◦ Often blurts out an answer before a question has been completed
◦ Often has difficulty waiting his or her turn
◦ Often interrupts or intrudes on others

45

ADHD onset

DSM–5:Onset by *age 12* (DSM-IV:onsetage7)
-occurs for *>6 months* in more than one setting: school, home, public/peer (church, camp

46

ADHD tx

Stimulants : methylphenidate compounds, dextroamphetamine, amphetamine salts
(*Adderall, Adderall XR, Ritalin, Focalin, Concerta, Vyvanse*)
-effective 80% of the time!
MOA: *blocks reuptake and increases release of NE and dopamine*
-Augmentation of dopamine and adrenergic action throughout the CNS –prefrontal cortex is the target

47

ADHD tx SEs

*decreased appetite, weight loss, stunted growth, insomnia*, motor/vocal tics, headaches, *irritability*, hallucinations

48

ADHD tx non-stimulants

-Atomoxetine (Strattera) variation of TCA: 5HT
and NE reuptake inhibitor- 65% effective
-Alpha-2 agonists (clonidine, guanfacine), Buproprion hydrochloride (Wellbutrin XL), TCAs

49

Oppositional Defiant Disorder

A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least *6 months*

50

ODD criteria: at least four of the following

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

51

ODD: The disturbance in behavior is associated with ?
The behaviors do not occur exclusively during ??

distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning.
-do not occur only during the course of a psychotic, substance use, depressive, or bipolar disorder.
-Also, the criteria are not met for disruptive mood dysregulation disorder.

52

ODD tx

Behavior Modification
◦ Treating comorbid disorders, such as ADHD, may reduce ODD behaviors

53

Conduct disorder

severe disruptive behavior disorder
Prevalence: 1-10%
More common in boys
Genetic/environmental factors
High incidence of ADHD and learning disorders
*Up to 40% develop antisocial personality disorder

54

Conduct disorder

-Aggression to People and Animals

-Destruction of Property
-Deceitfulness or Theft
-Serious Violations of Rules (out passed curfew (younger than 13)
-run away from home overnight at least twice, often truant (younger than 13)


55

What adult disorder is Conduct disorder associated with?

Antisocial Personality Disorder
*Conduct disorder as a child is required for a diagnosis of antisocial personality disorder in adults.

56

Conduct disorder tx

Multi-systemic Therapy (MST):
intensive, family-focused and community-based treatment program

57

Enuresis criteria

Repeated voiding of urine into bed or clothes, whether involuntary or intentional
-at least *twice a week for at least 3 consecutive months*.
-*at least 5 years (or equivalent developmental level)*
-Nocturnal and Diurnal

58

Enuresis cannot be attributed to ??

the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure disorder)

59

Enuresis tx

Motivational Therapy
Bell and Pad Alarm
TCAs: Imipramine/Desipramine
Antidiuretic: DDAVP (desmopressin)

60

Encopresis criteria

inappropriate pooping
-At least *one/month for at least 3 months*
-*at least 4 year*s (or equivalent developmental level).

61

Encopresis is not attributed to

the physiological effects of a substance (e.g., laxatives) or another medical condition except through a mechanism involving constipation.

62

with encopresis, need to specify (via PE/hx) whether it occurs with or without ??

-With constipation and overflow incontinence:
-Without constipation and overflow incontinence

63

Disruptive Mood Dysregulation Disorder

Severe temper outbursts at least *3 TIMES A WEEK*
-Sad, irritable or angry mood almost every day, Reaction is bigger than expected
-Child must be at least *6 YEARS OLD*
-Symptoms begin before age 10
-Symptoms are present for *AT LEAST 1 YEAR*
-Child has trouble functioning in more than one place

64

DMDD tx

Target child’s symptoms:
◦ Irritability/sadness – antidepressant
◦ Temper outbursts – mood stabilizer – atypical antipsychotic
(Risperdal, Abilify)