child and adolescent emotional disorders

strong negative emotion and tension in anticipation of future danger or threat (worry)

emotional reaction to present
danger, characterized by alarm and strong
escape tendencies (fight/flight response may occur)

sudden fight/flight response in absence of obvious, real danger/threat

sympathetic nervous system initiates fight/flight response

attentional shift, hypervigilance,
nervousness, difficulty concentrating

aggression and/or avoidance

% of parents report that their children are too nervous, fearful, anxious

Excessive anxiety about being away from
home or apart from parents.
Must last >= 4 weeks Must occur before age 18. 4% prev, child>teen, girl>boys

Extreme, disabling fear of specific
objects or situations that pose little or no danger. Avg onset 7-8yrs; peaks by 10-13yrs
2-3% prev, child>teen, girl>boys

Excessive, uncontrollable anxiety and
worry about numerous events and activities.
Must last >= 6 months, Boys=girls, 2-4% prev, teen>child, girl>boys

Marked, persistent fear of being the
focus of attention or doing something humiliating. 1-3% of children (more common
in girls) Avg onset is 11-14 yrs (rare before
10yrs, BUT often described
as “always shy”)

Persistent failure to speak in social
situations, despite ability and willingness to speak in private with close
family/friends 90% also meet criteria for Social Phobia. Must last >= 1 month,
1% prevalence, child>teen, girls>boys

recurrent uncued panic attacks, plus persistent concern about having another attack or its consequences/implications. only 1% or less will actually have panic disorder.
Avg onset is 15-19 yrs. More common in girls.

a sudden, overwhelming period of
intense fear/discomfort accompanied by characteristics of the flight/fight
response. Panic attacks (3-4% adolescents) more common than panic disorder.

Anxiety about being in places where
escape would be difficult or embarassing, or where help is unavailable if have
panic attack or panic-like sx. can have it without panic disorder but it is rare (it
would mean that they did not have recurrent uncued panic attacks)

Exposure to Traumatic Event,
Afterwards, show 3 core features for > 1 month
1)persistent re-experiencing of the event,
2)avoidance of associated stimuli and numbing of general responsiveness, and
3)symptoms of extreme, increased arousal
Text says 3.7 for boys and 6.7 for girls (6month prevalence)

Innate variation in reaction to novelty
(overactive Behavioral Inhibition System)

releasing hormone (CRH) gene associated with proneness to anxiety (overactive Behavioral Inhibition System)
(It works on HPA axis and limbic system to produce increased CRH in nucleus of amygdala,and thus heightened fear in response to stressful situations – these
individuals have a stronger fear reaction to potentially dangerous situations)

Little Hans & horse

Little Albert & white rat

insecure attachment

corticotrophin-releasing factor systems become hyper-reactive to stress

>75% response rates for our most effective treatments. Some studies have found 95% response rates when combine effective treatments.

Step 1: Relaxation Training
Step 2: Generation of Hierarchy
Step 3: Graded Exposure using Relaxation to
keep anxiety level down

(1)Recognize anxious thoughts,
(2)Modify/challenge anxious thoughts
Identify/ recognize / monitor automatic thoughts,

Parent/family add-on to child CBT
(1) psychoeducation
(2) behavioral parenting skills
(3)family communication and problem solving skills
(4)personal anxiety management

Obsessions: repeated, intrusive,
irrational, and anxiety-provoking thoughts,
images or impulses
Compulsions: ritualized and/or excessive behaviors to relieve anxiety
or discomfort
2-3% of children (boys>girls; males=females in adults)

sudden, rapid, recurrent, nonrhythmic, stereotyped behavior
Motor vs Vocal Simple vs Complex

<1% of children (2-5x more likely in
boys) Modal onset 6-7 years (tics often
decrease in adulthood) Very high co-morbidity with OCD (35-50%); also some comorbidity with ADHD, behavior problems

Recurrent pulling out of one’s hair
Must result in noticeable hair loss
Increasing tension before pulling, or
when try to stop
Pleasure, gratification, or release of
tension when pull
Less than 1%, Modal onset in early adolescence

Skin-picking, wound-picking
¨Finger and thumb-sucking
¨Nail biting¨ Cutting, burning and other self-injurious behaviors
Other repetitive behaviors

Extreme, persistent, or poorly regulated
emotional states
2 types: Unipolar Depression (MDD, DD)
Bipolar Depression (BPI, BPII, Cyclothymia)

depressed mood (in children, it can be predominantly irritable mood)*** (Intense
depression – can’t snap out of it; Excessive crying; Irritability / anger diminished
interest/pleasure in activities*** (Anhedonia – things aren’t fun anymore; Social
withdrawal)

1 or more Major Depressive Episodes
Lifetime Prevalence: Less common in preschool and school-age
children@ 2% in children
Increases in adolescence and adulthood
@ 5-20% in adolescents
(up to 20% adults; @ 1 in 5 will have a
depressive episode in their lifetime)

At least 2 years (1 year) with depressed mood (irritable) most of the day, most days
Plus 2 or more: poor appetite or overeating
insomnia or hypersomnia
low energy or fatigue
low self-esteem
poor concentration or difficulty making decisions
feelings of hopelessness
No more than 2 months (1 month) without
depressive symptoms
Lifetime Prevalence:
Less common than MDD @ 1%
of children ; @ 5% of adolescents (about
6% of adults) Male= Female

Abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week (or causing hospitalization)
Excessive involvement in pleasurable activities with high potential for negative
consequences (e.g.,reckless behavior, out of control spending, gambling, high-risk sex,
investments)

Abnormally and persistently elevated, expansive or irritable mood lasting at least 4 days 3 or more of the same symptoms as Manic Episode

Manic Episode or Mixed Episode (Mania
+ Depression)
Note: Usually also have MDE but not required for dx
About 20% of adults with bipolar had 1st
onset during adolescence 15-19, (early adulthood is big time; then another
small peak is in later life like age 50)

Hypomanic Episode + MDE

Hypomanic Episode + Depressive Symptoms

: Anger turned inward is
short description – depression results from the actual or symbolic loss of a
love object - mad at loved one for abandonment/rejection but turn it against
self bc would be too terrible to express it outward (superego stops you) – Since Freud
felt kids did not have a mature superego, they would not do this and so would
not experience. Anger turned inward Children incapable of depression

Unresponsive or emotionally unavailable caregiving leads child to see self as unworthy and unlovable and others as undependable, so at risk for depression esp
in response to interpersonal stress

Similar to attachment, in that relationships are the key stressors for individual

difficulty regulating negative emotions
may lead a child to be prone to depression, avoidance or negative behavior may
be used to regulate distress, rather than problem-focused and adaptive coping
strategies

Depression results from lack of
response-contingent positive reinforcement

Our thoughts determine our feelings and actions; changing the way we think can change the way we feel and act.
make internal, stable, and global
attributions for the cause of negative events (my fault bc I suck and will always suck at everything)

Chronic medical condition: excessive body fat (BMI > 95th percentile)

Binge eating: Excessive amount of food in a short period of time. Sense of loss of control (eat fast, not hungry, well past fullness)
Guilt/remorse and embarrassment afterward (often done in secret)
No purging or compensatory behaviors
3.1% of girls, and 0.9% of boys

a)Refusal to maintain minimally normal body weight,
b)Intense fear of gaining weight, and
c)Disturbance in body
size perception (often see denial of thinness)

individual loses weight through diet, fasting, or excessive exercise

individual engages in episodes of binge eating or purging, or both

Recurrent episodes of binging (eating more in short time than most would and feel lack of
control over it)
Binging and purging at least 2x wk for 3 mos
Much more common than AN – about 1-3% in
adolescent/adult females. Avg onset 17-24

What drugs are used by teens?

1 or more in a 12 month period
Failure to meet work, school, home
obligations due to recurrent use
Recurrent use in hazardous situations
Legal problems due to use
Use despite having social or
interpersonal problems caused or worsened by use

3 or more during 12 month period
Tolerance
Withdrawal
Use more or longer than intended
Persistent desire or unsuccessful efforts
to cut down/control
Spend a lot time getting, using or
recovering
Give up or decrease social, occupational
or recreational activities bc of use
Use despite knowledge of having physical
or psychological problem caused or worsened by use
Subtypes: With or Without Physiological
Dependence

% of adolescents (12-17 yo)
meet criteria for substance abuse or dependence

% adolescents (12-17 yo) with other problems meet criteria for SUD

12-17 yo meet criteria for substance abuse/dependence

Of all psychological disorders covered in class, this disorder shows the highest death rate due to the disorder (or its complications).

Like OCD, an imbalance in this hormone is implicated in Eating Disorders