Midterm

Question 1

Multifinality

Answer 1

one event can lead to many outcomes eg. not all victims of CSA develop PTSD

Question 2

Equifinality

Answer 2

multiple causes can lead to the same outcome

Question 3

Etiology

Answer 3

cause of a disease or condition

Question 4

Nosology

Answer 4

branch of medicine dealing with classification

Question 5

Epidemiology

Answer 5

branch of medicine dealing with incidence, distribution, and control of diseases

Question 6

Prevalence of child/adolescent mental health problems

Answer 6

50% of mental illness sets in by age 14, 75% by age 24
Of 14-18 yr olds, - 32% have anxiety
15% have depression
49% meet criteria in DSM for at least one mental illness
27% have a severe disorder

Question 7

ACE’s

Answer 7

Adverse Childhood Experiences
50% of children have at least one
ACE score of 4 risks dying early, suicide attempts, depression, STIS

Question 8

Galen

Answer 8

humoral theory

Question 9

John Locke

Answer 9

tabula rasa, raise children with care, parents have all the control over how the child turns out

Question 10

Jean-Marc Itard

Answer 10

studied Victor the Wild Child=> critical periods for development

Question 11

Phillippe Pinel

Answer 11

father of French psychiatry, free people from mental institutions, moral treatment

Question 12

Ben Rush

Answer 12

American, reform for mentally ill, progressive

Question 13

Dorothea Dix

Answer 13

teacher and social reformer, 32 humane mental institutions

Question 14

Freud

Answer 14

psychoanalysis, talk about feelings, first to say mental illness is not inevitable

Question 15

Health paradox of adolescence

Answer 15

Peak strength, smarts, health, etc. BUT get sick more and die more than people older and younger

Question 16

Freud’s theory of development

Answer 16

oral, anal, phallic, latency, puberty

Question 17

Mahler’s theory of development

Answer 17

(separation and individuation from parents) normal autism, symbiosis, differentiate, practicing subphase, rapprochement, object constancy

Question 18

Erikson’s theory of development

Answer 18

stages of psychosocial development depending on important conflicts eg. infant as trust vs mistrust

Question 19

Piaget’s theory of development

Answer 19

(cognitive errors) sensorimotor, preoperational, concrete operational, formal operational

Question 20

risk factors for mental health

Answer 20

1 Poverty; about 30% genetic; 70% socioeconomic(good doctors and hospitals, economic stability, education, community, neighborhood)

Question 21

resilience factors for mental health

Answer 21

emotional regulation and self efficacy increase the ability to cope with stress

Question 22

Mild Intellectual Disability

Answer 22

Previously referred to as “educable”
Largest segment of those with ID (85%)
Typically develop social/communication skills during preschool years and have minimal impairment in sensorimotor areas, often indistinguishable until a later age (by late teens will acquire skills up to approx the 6th grade level)

Question 23

Moderate intellectual disability

Answer 23

“Trainable”
10% of ID
Learn Communication skills during early childhood
Will generally benefit from social/vocational training and with moderate supervision can attend to personal care
Difficulties recognizing social conventions which interferes with peer relations in adolescence
Unlikely to progress beyond the 2nd grade academically
Often adapt well to life in the community in supervised settings (performing unskilled or semiskilled work)

Question 24

Severe intellectual disability

Answer 24

3-4% of people with ID
Acquire little/no communicative speech in childhood; MAY learn to talk later on
Can master sight reading “survival” words
Able to perform simple tasks as adults in closely supervised settings
Most adapt well to life in the community, living in group homes or with families

Question 25

Profound intellectual disability

Answer 25

1-2% of people with ID MOST HAVE IDENTIFIABLE NEUROLOGICAL CONDITION THAT ACCOUNTS FOR IT Considerable impairments in sensorimotor functioning Optimal development may occur in a highly structured environment

Question 26

Down's syndrome

Answer 26

Most common chromosomal abnormality leading to an ID Nondisjunction of chromosome 21 Relative strengths: Visual (vs auditory) Social functioning Relative weaknesses: Language expression and pronunciation Generally viewed to suffer less severe psychopathology than other developmentally delayed groups After about 40 yrs of age, affected individuals nearly always demonstrate postmortem neuronal defects indistinguishable from Alzheimer’s Disease Females have better cognitive abilities and speech production compared to males Males have more behavioral troubles

Question 27

Fragile X Syndrome

Answer 27

Fmr-1 gene An example of a “dynamic mutation” where more mutations occur with successive generations Only 50% of females with the full mutation demonstrate IQs in the borderline/mild ID range vs 100% of males Increases the risk for ADHD and autism and social phobia Increasing deficits in adaptive and cognitive functioning with age Relative strengths: verbal long-term memory Weaknesses: short term memory, integration, sequential processing math and attention

Question 28

Fetal Alcohol Syndrome

Answer 28

More than 1 in 1000 Irritable as infants and hyperactive as children ADHD Teratogen amount: 2 drinks/day (smaller birth size), 4-6 drinks/day (subtle clinical features), 8-19 drinks/day (full syndrome) General problems: prenatal onset of growth deficiency, microcephaly, short palpebral fissures Syndrome can include: facial deformities (like cleft lip and protruding ears), CNS deformities, NECK deformity, Cardiac deformities, and other abnormalities

Question 29

Prader-Willi Syndrome

Answer 29

Deletion in chromosome 15 Infantile hypotonia(decreased muscle tone), hyperphagia (food seeking), morbid obesity, small hands and feet, mild to moderate ID Relative stability in adaptive functioning Relative Strengths: Expressive vocabulary, LT memory, visual/spatial integration and visual memory and unusual interest in jigsaw puzzles Relative Weaknesses Tantrums, emotional lability, mood symptoms, anxiety, skin picking, OCD in more than 50%

Question 30

Angelman Syndrome

Answer 30

Severe ID, seizures, ataxia and jerky arm movement (puppet-like gait), absence of speech, and bouts of laughter Deletion in chromosomes 15 In contrast to PWS, all identified cases of deletion traces to maternal chromosome 15 (illustrating genomic imprinting)

Question 31

Williams Syndrome

Answer 31

Id, supravalvular aortic stenosis “elfin-like” facies, infantile hypercalcemia, and growth deficiency Deletion of elastin gene Relative strengths: Remarkable facility for recognizing facial features Loquacious, psuedo-mature “cocktail party speech” Relative weaknesses: Adhd, anxiety

Question 32

Major findings from the MTA study

Answer 32

Multimodal treatment study Largest randomized control trial ever of psychiatric disorder Kids between 7 and 9yr 9mo Treatment arms: RX, behavior therapy, combined, community control Lasted 14mo Medication is better for core symptoms med=behavioral for social skills, peer socio ratings, academic, classroom observed beh Combination the best

Question 33

Factors important in making a convincing diagnosis of ADHD

Answer 33

Tests No single test Diagnostic must be multifactorial CPT: continuous performance test Use stroop and mazes, statue test(not diagnostic, but ADHD kids tend to do worse) Clinical interview Talk to family, teachers, other interview(MORE important than other ) Must have some symptoms by age 12 Rating scales(Conners, SNAP) Treatment trial: give medicine, if you respond well you have ADHD Never diagnose in 1on1 interview(ADHD kids often do well 1on1) Symptoms often show in group settings

Question 34

Age, gender, and race related differences in ADHD

Answer 34

Latino and black children are less likely to be diagnosed by parent report Children without insurance receive less attention in all domains Black children are less likely to receive stimulants

Question 35

Impairments in executive functioning with ADHD

Answer 35

Goal directed behaviors, including strategic planning, Parents sometimes have to be prefrontal cortex for child Do not lack empathy, just over it quickly Neuropsych testing shows where deficits are Inhibition of responses

Question 36

Brain areas implemented in ADHD

Answer 36

Group data only-- brain scans are not for individual child, cannot be used to diagnose Numerous imaging studies say: caudate nucleus and globus pallidus affected Command center(prefrontal cortex) is smaller posterior(coordination) affected Prefrontal cortex takes 5 years longer to develop than NT(no filter, emotionally immature) Not enough dopamine in receptors, adderall with increase dopamine

Question 37

History of DSM & major differences between versions

Answer 37

DSM I- did not have biological cause, considered "reactions" DSM II- breif descriptions of symptoms but no diagnostic criteria DSM III- provides diagnostic criteria, has separate section for childhood disorders, more reliable, removes homosexuality DSM IV- refined diagnostic criteria, gave background info, added Asberger's, ADD=>ADHD, multiaxial system DSM V- move away from categorical diagnosis and towards dimensional diagnosis, recognize crossover, cross cultural understanding

Question 38

What causes death and disability in adolescence

Answer 38

accidents, suicide, homicide

Question 39

Maturation of brain neural tracks & networks

Answer 39

as an adolescent, develop more synapses, which are pruned when transitioning to adulthood, grey matter=potential, white matter=mylienated

Question 40

Neonatal/childhood differences between males and females

Answer 40

girls: more internalizing problems, resilience comes from a female caregiver, get a rush from talking, more interested in faces, brains mature faster boys: externalizing problems, need a male role model, use fewer words than girls, more testosterone=> growth of amygdala(aggression), more interested in objects

Question 41

Adolescent risk taking behavior & why it occurs

Answer 41

striatum(love, anger jealousy) doesn't mature as fast as the PreFrontal Cortex(CEO of brain that makes decisions) dopamine, oxytocin

Question 42

History of present illness (what is addressed?)

Answer 42

all areas of life= current difficulties, recent stressors, neurovegitative status(sleep, energy), attention and concentration, appetite, medical history, family history, prior evaluations and treatment

Question 43

Major diagnostic categories to consider

Answer 43

PAM ATE A PEST: psychosis, anxiety, mood, ADHD, tics, externalizing disorders, PDD, eating disorder, self injurious behavior, trauma

Question 44

Components of the mental status exam

Answer 44

background info, behavioral info and observations, tests, summary, recommendations

Question 45

Biopsychosocial assessment (what is the purpose and what is included?)

Answer 45

biological psychological and social aspects, can explain why symptoms are happening

Question 46

Intelligence scales (most common)

Answer 46

Most common: Weschler scales- divided by age Other common tests: Stanford-Binet Intelligence Scale Kaufman Assessment Battery for Children Woodcock-Johnson Tests of Cognitive Ability

Question 47

IQ vs. Achievement Tests (describe the difference)

Answer 47

IQ: predict school achievement, relatively unchanging, descriptive, influenced by heredity and environment Achievement: measure current knowledge, directly affected by what the child has already learned if they are very different, there may be an achievement gap

Question 48

Identify the purpose of neuropsychological assessments & why you would do one

Answer 48

for learning and cognitive disability, normed and comprehensive, used if parents question the child's academic achievement or if teachers have concerns

Question 49

Domains assessed with neuropsychological testing

Answer 49

explain intelligence-academic gap explain variability between tests recommend specific accommodations can test motor skills, executive functioning, perception, language, memory

Question 50

IDEA, U.S. Public Law 101-476

Answer 50

``` individuals with disabilities education act, access bill: every disabled child must have access to Free Appropriate Public Education Appropriate Evaluation Individualized Education Plan Least Restrictive Environment Parent Participation Procedural Safeguard ```

Question 51

DSM diagnostic categories for learning disability

Answer 51

tests of reading, writing and math ability substantially (2 SD) below age, schooling and intelligence specific, not attributable to intelligence or other developmental disabilities

Question 52

dyslexia

Answer 52

Specific learning disorder with impairment in reading, distortion submissions and omissions of words, affect 4% of kids, 60-80% are boys, can be caused by problems in decoding or comprehension

Question 53

decoding

Answer 53

tool that enables students to become proficient readers, sight words, reading rate and accuracy

Question 54

Factors that influence reading development

Answer 54

general intelligence, vocab, reasoning, concept formation, development of phonemic awareness and alphabet, automation of words

Question 55

Broca’s versus Wernicke’s Areas

Answer 55

Broca- motor expression in speech, production issues | Wernicke- understanding audible speech, comprehension issues

Question 56

History of ADHD

Answer 56

``` "fidgety phils" DSM II- hyperactivity syndrome DSM III- ADD + diagnostic criteria DSM IIIR- ADD becomes ADHD DSM IV- add subtypes ```

Question 57

Diagnostic and functional criteria of ADHD

Answer 57

18 symptoms, must have at least 6, some present before age 12, must be cross situational, persists for at least 6 months, social/academic/occupational impairment, inattentive, hyperactive/impulsive, or combined type

Question 58

Symptoms and prevalence of ADHD and subtypes

Answer 58

3-7% of kids in the US(most commonly diagnosed behavioral disorder in childhood) Inattention: Makes careless mistakes/poor attention to detail Difficulty sustaining attention in tasks/play Does not seem to listen when spoken to directly Difficulty following instructions Difficulty organizing tasks/activities Avoids tasks requiring sustained mental effort Loses items necessary for tasks/activities Easily distracted by extraneous stimuli Often forgetful in daily activities Hyperactive/impulsive: Fidgets Leaves seat Runs or climbs excessively (or restlessness) Difficulty engaging in leisure activities quietly “On the go” or “driven by a motor” Talks excessively Blurts out answers before question is completed Difficulty waiting turn Interrupts or intrudes on others

Question 59

Natural history of ADHD

Answer 59

Rule of “thirds”: 1/3  complete resolution 1/3  continued inattn, some impulsivity 1/3  early ODD/CD, poor academic achievement, substance abuse, antisocial adults symptoms present differently as age changes