Exam 2 Flashcards
(130 cards)
1
Q
major depressive episode (MDE) lasts for a period of __ weeks
-it is defined as a __ __ OR __ __ __ or pleasure in nearly all activities (anhedonia)
-plus at least ___ symptoms
A
-2 weeks
-depressed mood OR loss of interest
-4
2
Q
MDE is characterized by at least 4 of the following symptoms (along with depressed mood/loss of interest or pleasure in all activities)
-significant __ __ or __
-insomnia or ___ nearly every day
-psychomotor ___ or __ nearly every day
-fatigue or __ __ __ nearly every day
-feelings of __ or excessive or inappropriate __ nearly every day
-diminished ability to __ or __ or indecisiveness nearly every day
-recurrent thoughts of __ (not just fear), recurrent __ __ without a specific plan or a __ __ or specific plan.
A
-weight loss or gain
-hypersomnia
-agitation or retardation
-loss of energy
-worthlessness; guilt
-think; concentration
-death; suicidal ideation; suicide attempt
3
Q
major depressive episode (grief) is the response to a __ __ that may include symptoms that resemble a depressive episode and are appropriate to the loss.
-some distinguishing grief from true MDE factors include:
A
-significant loss
-Affect
Course over time
Emotions
Thought content
Self-esteem
Suicide ideation
4
Q
what are the differences in affect between grief and depression?
A
grief: empty feelings regarding the loss
depression: persistent depressive mood. Cant anticipate happiness
5
Q
what are the differences in emotions between grief and depression?
A
grief: Pain may come with bouts of positive emotions, humor, etc
depression: Persistent and consistent low mood
6
Q
what are the differences in though content between grief and depression?
A
grief: memories of the deceased
depression: self-critical rumination
7
Q
what are the differences in self-esteem between grief and depression?
A
grief: not effected
depression: SE is low, feels worthless. Self-Loathing
8
Q
what are the differences in suicidal ideation between grief and depression?
A
grief: Perceived failings compared to deceased. Particular rumination
depression: Wants to end life because of feelings of worthlessness. Feeling undeserving to live.
9
Q
a manic episode is distinct period (> ___ week) of abnormally elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy that often causes significant impairment.
A
1 week
10
Q
a manic episode has at least 3 of the following symptoms + an expansive mood
-Inflated __-__ or __
-Decreased need for __
-More __ than usual or pressure to __ __
-Flight of ideas/__ __
-Distractibility
-Increased goal-direct activity or __ __
-Excessive involvement in __ __ __
A
- self-esteem; grandiosity
-sleep
-talkative; keep talking
-racing thoughts
-psychomotor agitation
-high risk activities
11
Q
a ___ episode is less severe than a manic episode with 3 symptoms from manic list
-does not cause significant impairment in fx
-mood is heightened and expansive but for a shorter duration (lasts at least 4 days)
A
hypomanic
12
Q
__ __ disorder is the presence of at least one manic episode. There may or may not be a history of hypomanic or major depressive episodes.
A
bipolar I
13
Q
__ __ disorder is the presence of one or more hypomanic episodes and major depressive episode
A
bipolar II
14
Q
__ disorder is the disturbance in mood that lasts for at least 1-year with no more than 2 consecutive symptom free months. Alternate between hypomanic episodes and periods of depression that are too mild to be considered MDD (e.g., don’t meet criteria for manic episode or MDD).
A
cyclothymic
15
Q
__ disorder presents itself in school settings with:
-__/expansive mood:
extremely happy, silly, and/or giddy
emotions do not match the context
-__
extreme outbursts and temper tantrums
often referred to as “out of control”
A
-bipolar
-euphoria
-irritability
16
Q
What are some symptoms to look for in a school setting with bipolar disorder?
A
-Need for movement
-Poor relationships
-Difficulties with concentration and focus
-Difficulties with task completion
-Impaired judgment and impulsivity
-Disorganization
-Becoming overwhelmed with stressful situations
17
Q
what is the prevalence and course for bipolar disorder?
A
-lifetime prevalence: 3-6%
-equal prevalence of males and females
-pediatric bipolar = poorer outcomes (more debilitating, irritability, rapid cycling, higher suicide rate)
18
Q
bipolar disorders are comorbid with what other disorders?
A
-Attention Deficit Hyperactivity Disorder (ADHD)—60-80%
-Oppositional Defiant Disorder (ODD) & Conduct Disorder (CD)—70-75%
-Substance Abuse—40-50%
-Anxiety Disorders—35-40%
19
Q
Bipolar Disorder and ADHD Similarities
-Bipolar Disorder
1. More __ than usual
2. ___
3. Increase in __ __ __ or psychomotor agitation
-ADHD
1. often __ excessively
2. is easily __ by extraneous stimuli
3. is often “__ __ __” or acts as if “driven by a motor”
A
- talks
-distractibility
-goal directed activity
-talks
-distracted
-on the go
20
Q
How is Bipolar different from ADHD?
A
-Bipolar
1. a mood disorder
2. episodic
3. break things deliberately
4. Angry outbursts last longer than 30-minutes, even hours
5. Difficulty learning due to motivational issues
-ADHD
1.Affects attention and behavior
2. Chronic
3. Break things carelessly
4. Angry outbursts last 20-30 minutes
5.Difficulty learning due to co-existing LD
21
Q
major depressive disorder (MDD) is a period of at least __ weeks with a depressed mood OR loss of interest or pleasure in nearly all activities (most of the day, nearly every day)
-Plus at least 4 of the following symptoms:
-Significant __ __ or __ __
-Insomnia or __ nearly every day
-Psychomotor __ or __ nearly every day
-Fatigue or __ __ __ nearly every day
-Feelings of __ or __ or inappropriate __ nearly every day
-Diminished ability to __ or __ or __ nearly every day
-Recurrent thoughts of __ (not just fear of dying), recurrent __ __ without a specific plan or a __ __ or specific plan.
A
-2 weeks
-weight loss; weight gain
-hypersomnia
-agitation; retardation
-loss of energy
-worthlessness; excessive; inappropriate guilt
- death; suicidal ideation; suicide attempt
22
Q
what are some emotional symptoms of MDD?
A
-Dysphoric mood
-Angry or irritable mood
-Anhedonia
-Weepiness
-Feeling unloved
-Self-Pity
23
Q
what are some cognitive symptoms of MDD?
A
-going to see negative self evaluations
-feel as if anything that goes wrong is their fault
-have a lot of negative automatic thoughts
-negative/flat affect
-low self-esteem
-feelings of hopelessness
-difficulty concentrating
-memory problems
-indecisiveness
-thoughts of suicide
-children devalue their own accomplishments/dismiss praise
-distortions in thinkings (“I cant do this…”)
24
Q
what are some behavioral symptoms of MDD?
A
-depressed mood
-decreased energy
-irritability
-decline in academic performance
-decrease in personal hygiene/self care/interest in appearance
-loss of interest in activities
-small tasks are overwhelming
-social withdrawal
-crying
-complaining
-excessive absences from school
-school refusal/activity
-increased risk taking behavior
25
what are some physical symptoms of MDD?
-tend to be very tired/fatigued
-somatic/physical complaints
-change in appetite
-change in sleep patterns
-dont have a lot of energy
-psychomotor agitation or retardation
26
how does depression present itself developmentally among preschool aged children?
-Separation anxiety
-Irritability
-Sad affect
-Tearful
-Not interested in play
-May appear withdrawn
-Negative comments
-physical complaints
27
how does depression present itself developmentally among school-aged children?
-Increased irritability
-Lack of interest/pleasure in activities they once used to enjoy
-Sad appearance
-Angry outbursts
-Temper tantrums
-Low frustration tolerance
-Negative self-statements
-Physical complaints
-Problems with peers
-Academic problems
28
how does depression present itself developmentally among adolescents?
-Sleeping/eating disturbances
-Low self-esteem
-Self-critical
-Feelings of hopelessness/worthlessness/guilt
-Lack of energy
-Loneliness
-Declines in academic performance
-Negative body image/self-conscious about appearance
-Behavioral problems
-Increased thoughts about suicide
-Eating disorders
-Substance abuse
-Cutting
29
What is the prevalence and gender differences for depression?
Rare in preschool children: 1%-2%
Rare in school-age children; 1%-3%
Sharp rise in adolescents: 5%-6%
Gender differences
Children: males = females
Adolescents: 2:1 female to male ratio
30
depression is comorbid with what other disorders?
-Is the rule rather than the exception
-Present in approximately 90% of youth with MDD; 50% have more than 2 co-morbid disorders
-Most common co-morbid disorders of MDD:
-Persistent Depressive Disorder
-Anxiety Disorders (kids-separation anxiety; adolescents—GAD, social phobia)
-ADHD and other Disruptive Behavior Disorders
-Substance-related Disorders
-Borderline Personality Disorder (60%)
-Eating Disorders
31
What is the onset, course, and outcome for depressive disorders?
-Most depressive episodes have an onset b/w 13 and 15.
-Average episode is 8 months
-Recovery from initial depressive episode is not always permanent.
-chance of recurrence of about 25% within 1-year, 40 within 2-years and 70% within 5-years
32
persistent depressive disorder (__) is a depressed mood or irritability on most days, for most of the day for at least __ years ( __-year for kids; mood may be irritable)
-dysthymia
-2 years
-1 year
33
persistent depressive disorder is a depressed mood/irritability on most days, with at least 2 of the following symptoms (including depression):
-Poor __ or __
-__ or hypersomnia
-Low __ or fatigue
-Low __-__
-Poor __ or difficulty __ __
-Feelings of __
- appetite; overeating
-insomnia
-energy
-self-esteem
-concentration
-hopelessness
34
Misc. facts about persistent depressive disorder (dysthymia)
-symptoms for persistent depressive disorder havent remitted for more than __ __
-criteria for MDE during 1st __ years (1 year for kids) may be present
-no manic or __ episodes
-clinically significant __ or impairment
-early onset: < __ years
-2 months
-2 years
-hypomanic
-distress
-21
35
Kids with Persistent Depressive Disorder tend to be:
-__ & __
-__
-__
Kids with Persistent Depressive Disorder tend to have:
-__ __ __
-__ __-__
-Irritable & cranky
-Depressed
-Pessimistic
-Poor social skills
-Low self-esteem
36
What are should we be looking for in kids with persistent depressive disorder?
-Feelings of sadness
-Hopelessness
-Self-deprecation
-Low self-esteem
-Pessimistic
-Poor social skills
-Irritability/cranky
-Anger
-Temper tantrums
-Academic problems/poor school performance
-Social/peer problems
-Non-specific physical complaints
-Frequent absences from school
-Talk or efforts to run away from home
-Outbursts or shouting, complaining, or crying
-Lack of interest in playing with friends
-Alcohol/substance abuse
-Social isolation
-Increased anger, hostility
-Reckless behavior
37
How does depression impact school behavior?
-Memory
-Executive Functioning
-Social Withdrawal
-Behavior Problems
-Emotional Hypersensitivity
38
What is Persistent Depressive Disorder comorbid with?
-Anxiety disorders (separation anxiety and GAD are the most common)
-Substance Use Disorders
-Behavior Disorders (ADHD, Conduct disorder)
-Personality Disorders
39
What is the onset, course, and outcome of Persistent Depressive Disorder?
-Typically an early, insidious onset, and chronic course
-Early-onset is highly associated with comorbid personality and substance use disorders
-Symptom duration lasts 2-5 years with an average of 2-years
-Approximately 70% of kids eventually develop MDD within 5-years
40
How is Bipolar different than Depression?
-presence of manic episodes (bipolar needs 1 manic episode to diagnose)
41
What are the predictors of duration and relapse for MDD and persistent depressive disorder?
-age of onset
-psychotic symptoms
-prior history of depressive disorder
-depressive cognitive style
-subthreshold symptoms after recovery (dont go back to baseline level of functioning)
-recent stressful life events
-adverse family events
-family history of MDD
42
What is the different between MDD and Persistent Depressive Disorder?
MDD: Depressed mood present for most of the day, nearly every day for at least 2 weeks
Persistent Depressive Disorder: Depressed mood occurs for most of the day, more days than not for 2 years (1 year in children)
43
disruptive mood dysregulation disorder is the severe recurrent verbal and/or behavioral temper outbursts that are grossly out of proportion to situation for at least __-__
1 year
44
Some symptoms of disruptive mood dysregulation disorder include:
-Outbursts are developmentally __
-Occur frequently
-Mood between outbursts is persistently __ or __ most of the day, nearly everyday
-No more than __ consecutive symptom free months
-Symptoms present in at least __ settings
-Never had a manic or __ episode for more than __-day(s)
-Dx is not made prior to age __ or after age __
-inappropriate
-irritable; angry
-3
-2
-1
-6; 18
45
what is the prevalence of disruptive mood dysregulation disorder?
-Estimates are unclear
-6-month to 1-year prevalence is 2-5%
-Higher in males and school-age children
46
what is the development and course of disruptive mood dysregulation disorder?
-onset must be before age 10
-Dx should not be given to children with developmental age less than 6 (should be restricted to age 18)
-rates of conversion to bipolar are low
-kids are at risk to develop depressive disorder and anxiety disorder in adulthood
47
what disorders are comorbid with disruptive mood dysregulation disorder?
-rates are very high
-very rare to find children with this disorder alone
-strongest overlap is with ODD
-DMDD tends to be more severe than ODD but commonly co-diagnosed
-disruptive behavior, mood, anxiety, and autism spectrum disorders
48
Etiology of Depression
-Genetic:
__ disorders and __ tend to occur in families
-Environment
__ life events
__ of family member or pet
__
Moving to a new school
__
-depressive; suicide
-stressful
-death
-divorce
-breakup
49
Attributional Theory: Learned Helplessness Model
1. Aversive Event -->
2. Attributional Style (leads to either 3/4)
3. External, unstable, specific attributions (ends here.)
4. Internal, stable, global attributions (continues to hopelessness and depressive symptoms)
50
Cognitive Behavioral Therapy
-Skills oriented tx
-Assumption:
-depression is caused or maintained by __, __ thought patterns and a lack of reinforcing, pleasurable experiences
-CBT helps:
-Identify __ __ __
-Evaluate the __ of these thoughts
-Generate more __ __
-negative; automatic
-negative automatic thoughts
-validity
-realistic alternative
51
What are some assessments for depression?
-Children’s Depression Inventory (CDI)
-Reynolds Adolescent Depression Scales (RADS)
-Beck Depression Inventory for Primary Care (BDI-PC)
52
Assessments for depression are looking at:
-Classroom behaviors (skipping school)
-Declines in performance
-Interpersonal behaviors
-Personal behaviors
-Verbal behaviors
53
Some medication for depression includes:
-Fluoxetine (Prozac) is the only FDA approved med for MDD in children 12 and under.
-Lithium is the only mood stabilizer approved by the FDA for treatment of bipolar disorder in children and adolescents > 12 years of age.
-Lithium can cause tremors, nausea, vomiting, diarrhea, seizures, coma, kidney failure
54
what are some depression medication side effects?
-Headaches
-Irritability
-Blurry vision
-Restlessness
-Weight gain
-Trouble sleeping
55
What is the black box warning that appears on antidepressants?
-The FDA adopted a "black box" label warning indicating that antidepressants may increase the risk of suicidal thinking and behavior in some children and adolescents.
-A black-box warning is the most serious type of warning in prescription drug labeling.
-Medication may increase the risk of suicide
-Risk needs to be balanced with clinical need
-Monitor closely for signs and symptoms of worsening symptoms, suicidality, or unusual changes in behavior
56
How does Affective Education (a treatment for depression) work?
it increases students’ understanding and awareness of emotions
57
How does activity scheduling (a treatment for depression) work?
-Deliberately scheduling positive activities
-Reduce time spent in isolation
-Disconfirms negative automatic thoughts that:
-they are helpless
-they are unable to function
-they are unable to enjoy anything
-Good for all ages
58
What are some affective education (depression treatments) techniques?
The Emotional Thermometer
-Good for children of all ages
- Steps in employing the emotional thermometer
The Emotional Pie
-Good for adolescents
-Steps in employing the emotional pie
The Daily and Weekly Mood Log
-HW activity
59
how do we detect automatic thoughts and beliefs in children with depression?
-Thought Charts (good for older children/adolescents)—see handout
-Inference Chaining (good for older children/adolescents)
60
how do we identifying cognitive distortions in children with depression?
Help student ID these errors in their thinking
-Use language and labels that are appropriate to student’s developmental level
61
how do we change negative automatic thoughts and beliefs in children with depression?
Triple-Column Technique
-ID and replace negative thoughts with more realistic and more adaptive cognitions.
-Good for older children
62
what are some school-based modifications and accommodations for children with depression?
Social strategies
-Develop a relationship with the student
-Validate their feelings
-Foster positive social relationships
-Identify interests & incorporate into the day
-Provide them with responsibilities
Classroom accommodations
-Allow more time, Break assignments into smaller tasks
-Use a planner for organization
-Adjust the HW load
-Preferential seating
-Be flexible with deadlines
-Allow more “wait time”
63
what are some accommodations for children with Bipolar Disorder?
-Adjust for medication needs, dispensing, as well as plans for addressing side effects
-Provide student with a safe place and person to go to when feeling overwhelmed or stressed
-Shortened day (permit late start as needed)
-Prior notice of transitions
-Consistent schedule
-Scheduling the student’s most challenging tasks at a time of day when the child is best able to perform
-Modified or shortened assignments
-Plan for unstructured times of the day
-Adjust for medication needs, dispensing, as well as plans for addressing side effects (e.g., sedation)
64
what are anxiety disorders?
characterized by the direct expression of anxiety and/or the avoidance of stimuli that, when present, would invoke anxiety
65
anxiety vs fear
-normal for kids to experience anxiety/fear growing up (at mild to moderate levels)
-anxiety is a mood state that characterized by a strong negative emotion and bodily symptoms of tension in which the child anticipates future danger or misfortune
-key element: strong negative emotion and element of fear (could be real or perceived)
66
what are some central characteristics for anxiety?
-child is afraid of an event that has real danger or imagined danger (perception vs reality)
-anxiety is future oriented
-feels of apprehension and lack of control over upcoming events that might be threatening
-felt when no danger is actually present
-if child believes a threat exists, anxiety will occur
-fear is an immediate alarm reaction to a current danger
67
Common Fears by Age
0-6 ms: Loss of physical support, loud noises
7-12 ms: Strangers, sudden/unexpected/looming objects
1 yr: Separation from parents, injury, toilet, strangers
2 yrs: Loud noises, animals, dark rooms, separation from parent, large objects, change in environment
3 yrs: Masks, the dark, separation from parent
4 yrs: Separation from parent, animals, the dark, noises
5 yrs: Animals, “bad” people, separation from parent, bodily injuries
6 yrs: Supernatural beings (ghosts/witches), bodily injuries, thunder and lightning, the dark, sleeping or staying alone, separation from parent
7-8 yrs: Supernatural beings, the dark, staying alone, bodily injuries
9-12 yrs: Tests and exams, school performance, bodily injuries, physical appearance, social concerns, thunder and lightning, death
Adolescence Personal relations, personal appearance, school, political issues, future, animals, supernatural phenomena, natural disasters, safety
68
what are some common worries of children?
-Being around strangers
-Being embarrassed
-Performance in sports
-Doing homework, being late for school, changing schools, not getting good grades.
-Health problems or becoming sick
-Looks/appearance
-Being left out of a group, not getting along well with teachers, children (not being liked)
-Personal harm from other children, family or others.
-Separation from the family.
-A few may worry about war, money, disasters, and dying.
69
Anxiety's Three System Response
Physiological/Somatic
-racing heart, sweating, nausea
Cognitive
-worry, fear, irrational thoughts; problems concentrating
Behavioral
-avoidance, tearfulness, compulsions, freezing
70
Characteristics of Anxiety by developmental stage
-young children experience more symptoms but are primarily due to separation anxiety
toddlers
-clinging and crying behaviors
school aged children
-somatic complaints
-school refusal
teenagers
-excessive worry
-appetite and sleep disturbances
71
what is the prevalence rate for anxiety disorders?
-girls experience anxiety more than boys (2:1 ratio)
-Current/short-term (3 month) prevalence:
2%-4%
-6-month, 12-month, or lifetime prevalence:
10%-20%
72
Etiology of Anxiety Disorders
-Heredity
-anxiety occurs in families
-families may influence the development of anxiety by the environment
-exposure to frequent and/or stressful events and seeing adults coping style
73
Etiology of Anxiety Disorders
-life events
-teased/bullied by peers
-frightening experience with large animal
74
Etiology of Anxiety Disorders
-Warning Signs
-sweating, nausea, excessive talking, pacing or trembling
-changes in sleep and eating patterns
-being very clingy to parents (young children)
-staying home from school in excessive amounts
-incessant worry about appearance/clothing
75
Etiology of Anxiety Disorders
-Parenting and Anxiety Disorders
-overprotective parents limit childs growth
-doesnt allow them to overcome certain factors
-does more harm than good
76
What are some assessments of childhood anxiety?
Narrow band rating scales (child self-report)
-Multidimensional Anxiety Scale for Children
-Revised Children’s Manifest Anxiety Scale
-State-Trait Anxiety Inventory for Children
-Fear Survey Schedule for Children
77
__ __ are the extreme/unreasonable fears of a specific object/situation
specific phobias
78
__ __ is the extreme/unreasonable fear of being embarrassed or humiliated in front of others
social phobia
79
__ __ __ is the excessive worry about separation from home or loved ones
separation anxiety disorder
80
__ __ __ is the persistent/excessive worry about a number of things
generalized anxiety disorder
81
__ = subcategory of fear that:
-Is out of proportion to demands of situation
-Cannot be explained in a reasonable way
-Is beyond voluntary control
-Leads to avoidance of feared situation
phobias
82
what fears are normal for infants?
Stranger anxiety (7-8 months)
Separation anxiety (12-18 months)
83
what fears are normal for toddlers?
Toileting, personal injury
84
what fears are normal for preschoolers?
monsters, imaginary creatures, dark, animals
85
what fears are normal for elementary schoolers?
Thunder and lightening, supernatural beings (ghosts), dark
86
what fears are normal for middle schoolers?
Health issues (dentist); authority figures (principal)
87
what fears are normal for high schoolers?
Peer embarrassment, global issues, catastrophic events
88
a __ phobia is the extreme and disabling fear of objects or situations that in reality pose little or no danger or threat, and children go to great lengths to avoid them
-Phobic object/situation provokes __ fear/anxiety
-Phobic object/situation is actively __ or endured with intense __/__
-__/__ is out of proportion to the actual danger posed by the object/situation
-Duration of at least __-months
-specific
-immediate
-avoided; fear/anxiety
-fear/anxiety
-6 months
89
what are the prevalence rates for specific phobias?
-5% in children
-16% in 13-17 year olds
90
what disorders are comorbid with specific phobias?
-other anxiety disorders
-depressive & bipolar disorders
-substance disorders
-somatic symptoms
-personality disorders
91
what is the onset, course, and outcome of specific phobias?
-typically followed by a traumatic event
-may be the result of observing traumatic events others have experienced
-parental over-protectedness
-parental loss/separation
-abuse
-typically develops before age 10 (median 7-11 y.o.)(mean 10 y.o.)
-must remember that certain symptoms are prevalent in normal children/developmentally appropriate
92
How are specific phobias treated?
Participant modeling
-Superior to observing models on film
-Superior to mental imagery of feared situation (covert/imaginal participation)
Reinforced Practice
-Systematic desensitization
-Relaxed state of mind is incompatible with anxiety
-Successive approximations to feared object/event
-Involves:
-Developing a fear hierarchy
-Teaching deep relaxation
-Pairing fear hierarchy with deep relaxation
Cognitive Behavior Therapy
93
How can relaxation training help anxiety disorders?
-Designed to help calm the body and mind
-May be done individually or in groups
-Provides a method to cope with stress, frustration, anxiety and anger
-Teach children that relaxation techniques are not only helpful, but an accepted part of the school day
-Help children generalize these skills and use the techniques at home as well as in school
-Should be practiced for at least 3-4 sessions to ensure proficiency
94
What are the 2 types of relaxation techniques used to help treat anxiety?
-Imagery: Find a comfortable place and close your eyes. Listen to relaxing music if you wish. Imagine that you are in a place or situation where you feel safe, calm and happy. Try to re-create the experience by imagine how you feel, what you are tasting, what you hear, what you smell, and what you see.
-Deep Breathing: Take a deep breath through your nose. Hold it for 5 seconds (count using your fingers or to yourself—not out loud) and then very slowly, release your breath through your mouth. (Repeat at least two more times or until you feel calm.)
95
What are some other examples of relaxation techniques?
-Listen to music
-Exercise, Yoga
-Deep breathing
-Read
-Talk a walk
-Listen to the ocean
-Use Imagery
96
How does systematic desensitization help anxiety disorders?
-First need to teach relaxation skills in order to extinguish anxiety
-Once these skills are taught, you use them to react to a hierarchy of fears.
-Generating a graded hierarchy
-Graded exposure in practice
-List situations that make the child anxious
-Rate the anxiety that each situation provokes
-Rank situations from least to most stressful
97
What is an example of a Graded Hierarchy?
10: Going to a b-day party where you don’t know anyone
9: Going to a b-day party where you know almost all of the kids
8: Having a sleepover at your home (just 1 child)
7: Going to another child’s home for a play date
6: Having a child over for a play date
5: Playing with at least one classmate at recess
4: Raising your hand and asking your teacher a question
3: Raising your hand and answering one of your teacher’s questions
2: Having a brief (less than 5-min) conversation with a classmate
1: Saying “hi” to a classmate
98
__ __ disorder is the excessive anxiety concerning separation from home or attachment figures
-Anxiety is beyond what is developmentally expected and must last at least __ weeks.
-Must occur before __ years old
-Must cause significant __ or __ in social or academic functioning.
-separation anxiety
-4 weeks
-18 years old
-distress or impairment
99
Separation Anxiety Disorder requires at least __ of the following symptoms:
-Anticipation of separation results in __ __
-Excessive fears of the caregiver succumbing to an __ or __
-Excess __ that an event will trigger __ at some future time
-Refusal to go to __, out, __ from __
-Fearful of being __/__ __
-Reluctance to __ __ w/o caregiver or sleep __ from home
-__ about separation
-Repeated __ complaints (headaches, stomachaches) when separation from attachment figures occurs or is anticipated
-3
-excessive distress
-accident or harm
-worry; separation
-school; away from home
-alone; without caregiver
-sleep alone; away
-nightmares
-physical
100
Separation Anxiety Disorder
-Etiology
-Genetics
-Parental overprotection
-Loss or trauma
101
Separation Anxiety Disorder
-Prevalence and Comorbidity
-Approximately 4%; more prevalent in girls
-GAD; specific phobias
102
Separation Anxiety Disorder
-Onset, Course, Outcome
-Earliest age of onset (7-8 years) that progresses from mild to severe.
-Often occurs after experiencing stress (move, death, illness in family) or an extended vacation.
-Reasonably socially skilled
-School performance may suffer due to excessive absences
-Persists into adulthood
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__ __/__ __ is the refusal to attend classes or difficulty staying in school all day
school refusal
school phobia
104
__ __ is not a DSM-V diagnosis
-Equally common in boys and girls
-Begins between the ages of __ and __
-Most common during Pre-K, Kindergarten, 1st grade
-Tends to follow prolonged period of time __ __ __ __ (illness, holiday break, vacation), stressful event (change of schools), an accident, or death of a relative or pet
-Fear of __ is really a fear of leaving their __
-school refusal
-5; 11
-spent with a parent
-school; parents
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why do children have a fear of going to school?
-fear of submitting to authority/rules outside of home for the 1st time
-afraid of being compared to others/unfamiliar children
-fear of failure
-fear of being teased/bullied
-excessive/irrational fear of being socially isolated/embarrassed
-fear of meeting new people
-fear of being late for class or changing classes
-fear of public speaking
106
what are some implications of school refusal?
-academically, student will lag behind due to missed instruction
-social interaction and skills issues because they dont know/havent learned how to interact socially
107
what kinds of treatments are offered for school refusal/school phobia?
-ask child directly why they dont want to come to school
-CBT
-functional behavioral assessment (looks at specific functions of behavior)(evaluates the reason why student wont come to school)
-behavioral approaches towards school refusal (specific guidelines child must follow)(providing rewards to certain goals)
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__ __ disorder is the excessive pervasive worry about a number of events (family, friends, school, health, and performance)
-The appropriateness of past behavior, possible injury or illnesses (to themselves or others), the possibility of major calamitous events, their ability to live up to expectations, their competencies in various areas, being accepted by others, other things related to concerns about the future.
-Pervasive mood present on more days than not for at least __ months
-generalized anxiety disorder (GAD)
-6 months
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__ __ disorder is characterized by difficulty controlling the worry.
-__ symptom in kids (adults required to have > 3):
-Restlessness, easily fatigued, irritability, concentration problems, muscle tension, sleep problems.
-Anxiety, worry, or physical symptoms cause __ or ___
-generalized anxiety disorder
-1
-distress or impairment
110
Other things to remember about GAD
-Lifetime prevalence = __%
Kids may be:
-Perfectionistic
-__ __
-Require excessive __ from others about their performance
-Physically impacted by __ __
-Reluctant to engage in activities outside the home
-“Fly below the radar” of school personnel
-“Hard working” & “conforming”
-Rarely referred for __/__
-9%
-approval seeking
-reassurance
-heightened anxiety
-assessment/treatment
111
what are some treatment options for GAD?
-Cognitive Behavior Therapy (CBT)
-Modeling
-In vivo exposure
-Relaxation Training
-Reinforced Practice
112
__ __ __ (social phobia) is the clinical picture of a child with social phobia is one where the child displays phobic responses to one or more social situations.
-Speaking, eating, or drinking in front of others
-Acting in a way that shows __, resulting in __ __, and thus, embarrassed/humiliated
-__situations provoke anxiety
-Social situations are avoided or endured with __
-Fear is out of proportion to actual threat posed by social situation
-social anxiety disorder
-anxiety; negative evaluation
-social
-distress
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Social Phobia
-Etiology
-heritability component
-direct conditioning: child may have been embarrassed in social situation and now is resulting in social phobia
-observational learning to cause SP (might have seen someone else get embarrassed)
-cognitive biases (negative expectations about social interactions)
114
Social Phobia
-Treatment
-exposure to response prevention
-can be combined with cognitive restructuring, social skills training
-medication can be used
115
Social Phobia
-1 specifier in DSM-V
-must specify if it is performance only
-performance only SAD (children dont fear/avoid non-performance situations)
-public speaking/singing
116
in regards to social phobia:
-In __ __, the anxiety may be reflected in signs of distress
-In __ __, it may be expressed less dramatically
-__ __ __ phobic social situations are common, as are __ __ of anxiety such as muscle tension, heart palpitations, tremors, sweating, and gastrointestinal discomfort.
-Children with social phobias not only become anxious when actually confronted with socially phobic situations, but may also experience __ anxiety well before actually confronting these situation.
-young children
-older children
-attempts to avoid; physical manifestations
-anticipatory anxiety
117
social phobia: associated features
-children with social phobias can also show a range of associated features;
-Being __ __ to criticism,
-Having low levels of __-__,
-Having __ social skills.
-School performance may be __ due to problems such as __ __ and the failure to participate in classroom activities ,
-Again, these social anxieties can result in __ __ which may need to be treated itself.
-overly sensitive
-self-esteem
-inadequate
-impaired; test anxiety
-school refusal
118
Social Phobia: Treatment
-Approaches that have been found useful in treating social phobia include:
-CBT methods (to modify maladaptive self-statements and appraisals that can contribute to anxiety/avoidance)
-Cognitive restructuring
-Social skills
-Participant modeling
-Reinforced Practice
-In-vivo exposure
-Methods such as desensitization (to decrease anxiety responses in specific social situations)
-Modeling and operant approaches for teaching social skills and increasing social interactive behaviors.
-Psychopharmacological approaches have also been used in treating children with anxiety disorders .
119
Obsessive Compulsive Disorder
-___: Persistent and intrusive thoughts, ideas, impulses or images (they are excessive, irrational, and focused on unrealistic events.)
-__: Repetitive, purposeful, and intentional behaviors (e.g., hand washing) or mental acts (e.g., repeating words silently) that are performed in response to an obsession. However, they miss the mark and are excessive.
-obsessions and compulsions significantly interfere with the child's __.
-obsessions
-compulsions
-functioning
120
OCD
Prevalence
- __-__% equally common in adult males and females
-Male children have higher rates than female children
2-3
121
OCD
Comorbidity
-Tourette’s disorder
-Behavior disorder
-Substance-use disorders
-Learning disorders
-Eating disorders
-Depression
-Other anxiety disorders
-ADHD
-Trichotillomania (the repeated urge to pull out scalp hair, eyelashes, eyebrows or other body hair)
122
OCD
Onset
-symptoms typically begin during teenage years or in early childhood
-children can develop disorder @ an early age, even during preschool years (more likely to have family history if during preschool years)
-mean age = 19.5 y.o.
-25% of OCD cases are Dx by 14 y.o.
-males have earlier age of onset than females (25% beginning at 10 y.o.)
-onset symptoms are usually gradual (acute onset has also been reported)
123
OCD
Course and Outcome
-chronic course (with waxing and waning of symptoms)
-childhood/adolescent onset can lead to lifetime of OCD (typically before age 10)
-40% of individuals with childhood/adolescent onset experience remission in early adulthood
-course is complicated due to co-occurance of other disorders
-young childrens obsessions are more vague and less likely to feel abnormal (may ask endless questions related to them/no effort to hide discomfort)
-older children (over 8 y.o.) are aware of obsessions are not normal (tend to be uncomfortable talking about them)(try to hide/minimize them)
124
OCD Specifiers
-Individuals with OCD have dysfunctional beliefs
-inflated sense of responsibility and tendency to overestimate a threat
-perfectionism & tolerance of uncertainty
-over-importance of thoughts
-good or fair insight: recognize OCD beliefs are definitely/probably not true OR they may/may not be true
-poor insight: OCD beliefs are probably true
-absent insight/delusional beliefs: convinced that OCD beliefs are true
125
OCD Treatment
-Children with OCD are most commonly treated with a combination of psychotherapy and medication.
-The most common form of psychotherapeutic treatment is behavioral in nature and often takes the form of __ and __ __.
-With this approach, the patient is encouraged to confront the __ __ or __, either directly or via imagery.
-At the same time he/she is strongly encouraged to refrain from __ __ __ __.
-exposure; response prevention
-feared object or idea
-engaging in compulsive behavior
126
OCD Treatment
___
-Teach the child how to deal/cope with symptoms by changing how they deal with the things that make them anxious
-A major focus is on helping the child reframe their thoughts and learn coping statements to deal with the cognitive aspects of this anxiety-related disorder.
___
-Studies have shown that more than 3/4 of patients are helped by these medications to some degree.
-Medications relieve symptoms by diminishing the frequency and intensity of the obsessions and compulsions.
-Side effects can be an issue (Weight gain, dry mouth, nausea, diarrhea)
-CBT
-Medications
127
__ disorders are recurrent unexpected panic attacks with at least one panic attack followed by one month or more of::
-Persistent worry about having additional attacks
-Worry about the __ of the attacks
-Significant __ in __ because of the attacks
-panic
-implications
-change in behavior
128
a __ disorder is a discrete period of intense fear in which 4 of the following
Symptoms abruptly develop and peak within __ minutes:
-panic
-10 minutes
-Palpitations or rapid heart rate
-Sweating
-Trembling or shaking
-Shortness of breath
-Feeling of choking
-Chest pain or discomfort
-Nausea
-Chills or heat sensations
-Feeling dizzy or faint
-Derealization or depersonalization
-Fear of losing control or going crazy
-Fear of dying
129
-A panic attack (does)/(does not) equal a panic disorder
-panic disorder often has a __ and __ course
-does not
-waxing; waning
130
What are some treatments for panic disorders?
-Psychoducation,
-Elimination of caffeine, alcohol, drugs, OTC stimulants
-Cognitive-behavioral therapy
-Panic Control Therapy (PCT)
-Medications: SSRIs, venlafaxine, tricyclics, MAOIs, benzodiazepines, valproate, gabapentin
