Psych Final Exam Kids

Successful performance of mental functions that results in productive activities, fulfilling relationships & the ability to adapt to change or cope with adversity

Health conditions marked by alterations in thinking, mood, or behavior that causes distress, impair ability to function or both

A clinically significant, behavioral or psychological syndrome experienced by a person & marked by distress, disability, or the risk of suffering, disability, or loss of freedom

• All SES
• Determine Not developmentally normal
• —Preventive programs and interventions can improve social & emotional development, reduce risks

• Cicchetti
• Looks at numerous developmental and genetic, biologic theories
• Considers “nature” AND “nurture”

• Macro: Culture values beliefs
• Exosystem: Community geographical
• Micro: Family
• Ontogenic: Individual: Genes, brain, biology, temperament,

• —Critical Competencies
• Must be achieved to meet challenges of later stages
• Ex. Prosocial behaviors
• Individual and environmental factors interact in a reciprocal manner

• Cconsiders development & functioning
• Informed by genetic & neurophysiological variables
• Continuous exposure throughout life

• Risk Factors: Variables that impede development and cause hardship
• Protective factors: Variables that serve as buffers and have a helpful influence
• Proximal systems: variables with strongest influence/Closest
• Distal systems: variables exert less effects

Increase resilience to stress

• Positive self-image
• Family cohesion & absence of discord
• Support from significant others
• Positive relationship with at least one parent
• —Positive early family experiences with development of social competence
• —Family support
• —Academic achievement
• —Positive peer relationships

• Family history
• Immature development of the brain
• Brain abnormality
• Family problems & dysfunction
• Poverty
• —Mentally ill or substance abusing parents
• Teen parents
• Abuse
• Discrimination
• Chronic parental conflict, divorce
• Chronic illness or disability

• Long-term mental disorders in adulthood
• —Thwarted development
• Diminished productivity
• —Conflict within family and in community
• Child welfare involvement
• —Juvenile justice involvement
• —Special education
• Health

• —Cognitive development theory: Piaget
• Moral development: Kohlberg *
• —Attachment
• —Temperament
• —Brain development

• —Piaget
• —Intelligence: environmental adaptation
• —Two major Components:
• —Process of coming to know
• Stages we move through as we gradually acquire ability to know/think

a profound, reciprocal, physical and emotional relationship between a parent and a child that endures and sets the stage for all future intimate and trusting relationships.

• Set of expectations about self & relationships
• —Availability of attachment figure
• —Likelihood of receiving support during times of stress
• Ongoing interactions
• Become basis for all future relationships

• —Sensitive to the child’s needs and emotional states: Attunement
• —Responsive to the child’s needs and emotional states
• Accessible to the child
• Cooperative with the child

• —The Child seeks proximity
• —Communicates needs clearly
• —“any form of behavior that results in a person attaining or maintaining proximity to some other clearly defined individual who is conceived as better able to cope with the world”

• Avoidant
• —Ambivalent/Anxious
• Difficult to soothe

• Secure Attachment
• Insecure Avoidant
• Insecure Ambivalent
• Disorganized: A 4th response described more recently in children of abuse & neglect

• Self confidence
• —Competence
• —Loved
• —Lovable
• —World is predictable
• —I can deal

• Emotionally insulated
• —Hostile
• —Antisocial
• —Unduly seeking attention

• —Tense
• —Impulsive
• —Easily frustrated
• —Passive
• Helpless

• —Depression & other mental illnesses
• —Stress
• —Substance abuse
• —Childhood experiences
• Limited parenting knowledge
• —Abuse & Neglect
• —Domestic conflict
• —“Out-of –Synch” responses
• Anything that prevents parent from meeting the social, emotional and physical needs of their child in a sensitive responsive way

• —Medical, developmental issues
• Difficult temperament
• Inability to communicate needs clearly
• —Pushing parent away
• Being difficult to soothe

• How or style of behavior as opposed to why (motivation)
• —Easy
• —Difficult
• Slow to warm
• —Predictability to early school years

The brain develops and organizes as a reflection of developmental experience, organizing in response to the pattern, intensity and nature of the sensory and perceptual experience

• Synaptic Connections “The Wiring”
• Birth --> 50 trillion Synapses
• 1 year --> 1000 trillion Synapses
• —20 years --> 500 trillion Synapses
• How they connect is driven by experiences and emotional experience plays a crucial role in the minds architecture

• Areas of brain r/t fear are activated
• Other areas of brain are not activated

• Brains are 20-30 % smaller
• —Speech Delays
• —Hearing Problems
• Gross and Fine Motor Problems
• —SOCIAL DEFICITS

• Stress hormone
• Increased cortisol destroys synapses
• Maltreated kids have less cortisol after stress

• —Chronic Fear leads to state of hyper-arousal.
• This appears as hyper-vigilance and exaggerated autonomic responses
• —Heart Rate does not return to normal after startle.
• Reminders of trauma evokes fear response

• —Difficulty with self-regulation
• —Irritability in the limbic system can lead to panic disorder
• Smaller growth of the hippocampus and limbic system can increase the risk for dissociative disorders and memory impairments
• Children deprived of touch, movement, sound may be at risk for Sensory Integration Disorder.

• —Assessment
• —Family needs
• Promoting children’s rights in treatment settings
• Avoiding seclusion & Restraint

• —Children need simple phrases (more concrete)
• —Corroborate information with adult
• Direct questions, rather than open-ended
• May use play media
• May not be able to provide accurate time

• —Clinical interview: primary tool
• —Depends on developmental level of each child
• Establish a treatment alliance
• Assess interactions between child and parent

• Interview child and parent separately
• Children provide better information about internalizing symptoms (mood, sleep, suicide ideation)
• Parents provide better information about externalizing symptoms (behavior, relationships)

• Family assessment: usually done before assess’t of child/ teen
• Reinforce that everyone is involved and expected to work on problem how child is viewed : realistic or unrealistic

• Nature, severity, length;
• How upsetting?
• Better/ worse?
• Triggers/Events?
• Describe behaviors at home, response to discipline, empathy violence, risks

• Previous tx: Type length outcome; testing results & dx
• Family history: Medical MH problems; symptom in immediate & Extended family
• Developmental: Pregnancy HX ( Maternal health, stress, Substance use, physical abuse);Birth complications, developmental milestones,
• Social history: Names ages relationships with whom child lives; relationships with parents,sibs, other relatives, peers; activities hobbies; legal charges/ involvement
• Abuse history: Exposure to physical, sexual emotional abuse, CPS reporting/ involvement, treatment, exposure to family/ community services
• Chemical history: Substance use in child, parent, other caretakers
• Medical Hx: Seizure, head injuries, acute illnesses, injuries accidents, surgeries, loss of consciousness, asthma, et al chronic illnesses, vision hearing deficits, current medications, effects & S/E; names & effects of prior meds, Allergies
• School History: Current grade, reg/special ed,learning difficulties, behavior problems, peer & Teacher relationships, LIKE? HATE about school

Conducted via observation, use of play & Questioning; Behavior, play, orientation, memory, Attention & Concentration, speech, thought content & process, Hallucinations, delusions, SI/HI, Self-harm, thinking or actions, judgment, insight.

• —Ask for a detailed description of their view of problem
• Allow parents to express frustration
• Be nonjudgmental

• have difficulty putting feelings into words, thinking concretely
• Use play; conduct assessment in play room

• —able to use constructs, provide longer explanations
• Establish rapport through competitive games

• egocentric; have increased self-consciousness, fear of being shamed
• —Let them know what information will be shared with parents; direct, candid approach

• Ask straight forward questions
• —Have you thought about hurting yourself?
• —Have you ever acted on these thoughts?
• How would you hurt yourself?
• What do you think would happen?
• Have you ever hurt yourself?
• When a child shares information regarding an intent to commit suicide or hurt others, it must be shared with parents

• Build a relationship!
• Children want to behave and please those they care about
• All behavior has meaning
• —Children with mental health issues often cannot clearly communicate their needs
• —Addressing the need behind the behavior is essential to successfully

• Prevent & Early Intervention
• Starts Prenatally
• Screening
• In-home visits

• Individual
• Brief
• Play therapy
• Family therapy
• Parent training
• Group
• Milieu
• —Pharmacologic

• Cognitive or behaviorally based
• Help children modify behavior
• Behavioral: token economies, reinforcement of desired behaviors
• —Teaching parents to use
• —Behavioral contracts (teens)
• Problem solving, stopping negative perceptions

• Area for change, expression of feelings, trust, relationship building
• How kids talk
• Place to build rapport

• —Teaches family to alter children’s behavior in the home
• —Maladaptive parent-child interactions
• —Replace coercive behavior with pro-social behaviors
• Solid supporting data

• Strong evidence base for treatment of behavioral dysregulation
• Adapted for use with traumatized and maltreated children
• —Two treatment phases: Child-Directed Interaction (CDI) and Parent-Directed Interaction (PDI)

• initially for families with children ages 2-to-7 with oppositional, defiant, and other externalizing behavior problems.
• —It has been adapted successfully to serve physically abusive parents with children ages 2-to-12.

• Severe, untreated parental psychopathology
• Severe marital discord
• Children outside of the PCIT age range
• Severe ADHD without medication consultation (Project SHAPE)
• Parents/caregivers who are known perpetrators of sexual abuse

• —A two-stage approach aimed at relationship enhancement and child behavior management. (CDI & PDI)
• —Skills are taught then coached
• Assessment driven: progress charted on a graph
• Parents are provided with immediate feedback
• —Homework

• —Especially effective with Adolescent
• —Less threatening
• Universality
• —Windows of opportunity
• —Avoid with conduct disordered kids
• Social Cognitive group may be helpful in reducing aggressive behavior

• —Behavior of one affects whole family
• —Interventions focused on behavior patterns of entire family
• —Promotes cohesion, addresses concerns conflicts
• —Success necessitates modify family/ home environment

• —Few psychotropic meds have FDA Approval for use in children
• Rx’d “off label”
• —“black box” warnings with antidepressant use in children
• Name, action, dose, time, side effects
• Parents & Child
• —Safety issues related to storage, administration
• —Drug- drug interactions/ OTC drugs

• Always treat youngsters with respect and preserve their dignity.
• Always do what is in the child’s best interests.
• Seek solutions, not blame.
• Model tolerant, patient, dignified, and respectful behavior.
• Use the least intrusive intervention possible.
• —Connect and build strong personal bonds with them.
• —Instill hope for success
• NEVER give up on a child. Be perturbed with the actions of a child but keep believing in his/her ability to change for the better.
• —CATCH KIDS BEING GOOD . . . A LOT!!

• Label feelings
• Normalize and validate feelings
• —Identify & connect triggers to feelings
• —Identify & connect thoughts accompanying or preceding feelings
• Address/ reframe thought distortions
• Explore healthy expression of feelings
• Use of play media is effective in helping
• —Use of “some kids”, or third person helps

• —Persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level
• Hyperactive type
• Inattentive type
• Combined type
• No link to sugar, maybe food additives

• ODD
• Conduct DO
• Depressive Do
• —Early onset substance abuse
• Learning DO

• No specific “tests”
• Diagnostic tools include questionnaires such as Conner’s, for parents teachers and older kids
• Symptoms appear early 3-6yo
• R/O other possibilities

• AACAP, AAP:
• —Behavioral< FDA approved meds
• Stimualnts & amtomaxatine ( Strattera)
• PMT
• —Meds plus other treatment most effective
• —Goals: Improve self- regulation & Social functioning

• Stimulants: Adderal, Concerta, Ritalin
• Non stimulants: Strattera, ( watch closely for SI), Wellbutrin, clonidine, tricyclics
• Side effects: (stimulants) Sleep disturbance, Decreased appetite, Tics : less common

• Schedule
• Organize everything
• Use homework and notebook organizers
• Be clear and consistent
• Give praise and rewards when rules are followed

• Disobedience
• Argumentativeness
• Angry outbursts
• —Low frustration tolerance
• —Tendency to blame others

• —Behavior modification, parent training
• Family therapy
• —Medication used to treat co-morbidities

• —Serious violations of social norms
• Aggressive behavior
• Destruction of property
• Cruelty to animals

• Physical & Sexual abuse
• Inconsistent Parenting with harsh discipline
• Lack of supervision
• —Early institutional living or out-of- home placement
• —Association with delinquent peer group
• —Parental substance abuse

• —Behavioral techniques: —MUST be very consistent
• Medications for aggressive & Impulsive behavior: —Atypicals, mood stabilizers, lithium
• —Parent management training: Greatest promise

• Clinically or behaviorally significant symptoms appear within 3 months of an identified stressor
• Mood, anxiety, behavior or mixed
• —Course may be acute or chronic
• —May include regressed, fearful or acting out behavior
• —Requires support, understanding and encouragement
• —Adaptive coping skills

• OCD
• Phobias
• Separation Anxiety
• Social Anxiety disorder
• —Generalized anxiety disorder
• —Post traumatic stress disorder

• Suffer great distress when faced with ordinary separations from major attachment figures: Panic
• —Fear accidents befalling parents, cling or shadow parent, school refusal
• Somatic complaints
• Sleep disturbance

• Good response to SSRI’s
• Imagery, self-talk Cognitive techniques
• Teach parents helpful responses

• —Excessive unrealistic fears
• Past & Future
• Weather, school, health family finances
• Buspar & Paxil effective

• Response to trauma that person perceives as life threatening to self or other
• Children do not present the same as adults
• Adolescents may present with adult symptoms
• Presence of risk/ protective factors play role in development
• Ongoing or repetitive trauma
• Co- morbidity: MDD

• Re-experiencing
• Intrusive thoughts and nightmares
• Avoidance of discussion of the traumatic event and places or people
• —Amnesia important aspect of the trauma
• withdrawal from friends or usual activities
• detachment from others
• sense of —foreshortened future
• —Hyperarousal, such as sleep difficulties
• —Hypervigilance
• —increased startle response

• prolonged or repeated stressors
• —may present with predominantly dissociative features,
• including de-realization, depersonalization, self-injurious behavior, substance abuse, and intermittent angry or aggressive outbursts

• —may not experience amnesia
• may not have avoidantor numbing symptoms
• —mayor may not have visual flashbacks
• —may show frequent posttraumatic reenactment of trauma
• —skewed sense of time during the traumatic event.
• Sleep disturbances
• —A high prevalence of "omen formation“ \questions about foreshortened future may be meaningless in this age group

• May present with generalized anxiety symptoms (separation fears, —stranger anxiety, fears of monsters or animals)
• —avoidance of situations that may or may not have an obvious link to original trauma

• —Posttraumatic play
• (which is compulsively repetitive, represents part of the trauma, and fails to
• relieve anxiety)
• play reenactment
• social withdrawal
• restricted range of affect
• —loss of acquired developmental skills

• direct exploration of the trauma,
• —use of specific stress management techniques,
• —inclusion of parents
• Psychosocial: TF-CBT, —EMDR ( Adults only), —Psycho therapy
• Psychopharmacology: Symptom treatment currently used to treat symptoms, SSRI’s& tricyclics, Propanol, Guanfacine, Carbamapezine

• —Medications: Paxil & Luvox approved
• —Behavior therapy: exposure and response prevention
• —Cognitive Behavioral Therapy

• Depressed or irritable mood
• Low frustration level
• Over reaction
• Loss of joy
• Moodiness
• —Changes in appetite, sleep
• —Physical complaints
• —ANHEDONIA
• —Decreased ability to think, concentrate>>>> poor school functioning
• —Acting out: Substance abuse, truancy, running away, self injury, promiscuity
• —Thoughts or verbalizations about death
• Stressors

• —Half have another psychiatric illness
• —GAD
• OCD
• ADHD
• Conduct disorder

• —Cognitive-behavioral therapy: Positive Self-talk, Promote coping, Active participation in planning activities, —Self monitoring (Journaling about moods, feelings)
• Play therapy for younger children
• Family consultation: Help relatives understand, Develop more effective parenting skills, Communication, Teach about suicide risks

• —SSRIs: Low S/E: nausea, HA, Stomach ache, IMprovement1-2 weeks, Up to 12 weeks for full effect, Given for 6-24 months
• TCA’s: —More S/E, —Dysrhythmias!, —Potential lethality in OD
• Antipsychotics: Aggression, hallucinations delusions, Risperdal, Seroquel, Zyprexa, Sedating
• —Typical A.P. not given due to increase risk for TDK
• Discuss black box warnings with family

• Children: Delusions, hyper-sexuality, pressured speech, flight of ideas
• Teens: resemble adults, Hallucinations, labile mood, —Determining cycling is still difficult
• —“Affective storm”
• Rages
• Prone to violence
• —Poor school performance
• Sleep disturbance
• —Rapid mood swings: q 1-2 hours
• —Often symptoms seem to be chronic>>>> difficult to id cycling episodes

• Lithium: Serotonin norepinephrine and dopamine systems
• Diminishes dopamine effectsduring mania
• —Enhances serotonin effects during depression
• —Strong suicide preventive properties
• —Anti- convulsants: —Carbamazepine , Divaloprex, Rapid cycling and angry or depressed states
• Antipsychotics: with psychosis

• Watch for dehydration (Lithium)>>>>> lead to elevated lithium levels
• —Child may need to carry water bottle @ School

• Marked impairment of development in social interaction and communication
• Delayed and deviant language, or concrete thinking
• Pronoun reversals and abnormal intonation
• Stereotypic behavior: Repetitive rocking, Hand flapping, Insistence on sameness, Self-injurious behavior

• —Childhood Autism Rating Scale (CARS).
• CHAT
• Formal audiologic hearing evaluation and a lead screening

• For behavior
• —2006 approved Risperdal (risperidone)irritability, and include aggression, deliberate self-injury and temper tantrums.
• Off label: Zyprexa (olanzapine)

• —BLACK BOX WARNING:
• educate parents
• —fluoxetine, (Prozac®) has been approved by the FDA for both OCD and depression in children age 7 and older
• —(Luvox®), age 8 and older; sertraline (Zoloft®), age 6 and older; and clomipramine (Anafranil®), age 10 and older
• —can be associated with decreased frequency of repetitive, ritualistic behavior and improvements in eye contact and social contact

• Opioid antagonist: naltrexone for activity level and attention
• Clonidine: reduces hyperactivity, self-stimulation, and irritability
• Buspirone and trazodone: reduce agitation
• Lithium, and some of the benzodiazepines such as diazepam (Valium) and lorazepam (Ativan). The safety and efficacy of these medications in children with autism has not been proven.

• Severe and sustained impairment in social interaction and restricted, repetitive patterns of behavior, interests, and activities
• Profound social deficits: Inappropriate initiation of social interactions, —Inability to respond to social cues, —Concrete in interpretation of language, Stereotypic behavior
• Not associated with MR
• —Normal intelligence, good verbal skills, low performance

• Tourette disorder
• Chronic motor or vocal tic disorder
• Transient tic disorder
• Tic disorder NOS: Can suppress tics for brief periods, —Treatment with antipsychotics ( Haldol) and clonidine, —Ritalin can trigger onset/worsen tics

• Preschool-aged: —React more to others’ responses than to death itself, —Need reassurance, Avoid euphemisms (e.g., “he went to sleep”)
• School-aged: Unable to express feelings in a grownup way, Express grief through somatic complaints, regression, behavior problems, withdrawal, hostility
• —Adolescents: —Understand death as an abstract concept