Child & Adolescent Psychopathology Exam 2

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  1. Separation Anxiety Disorder
    • anxiety and fear concerning separation from home or major attachment figures
    • must be inappropriate for age
    • 4+ weeks
  2. Separation Anxiety Disorder Criteria
    • Excessive distress/worry:
    • -when separation occurs or is anticipated
    • -about losing or harm befalling attachment figures
    • -that an untoward event will lead to separation (getting lost/kidnapped)

    • Persistent reluctance, refusal, or fear:
    • -to go to school or elsewhere because of separation
    • -to be alone without major attachment figures
    • -to go to sleep away from attachments

    • Repeated:
    • -nightmares involving the theme of separation
    • -somatic complaints when separation occurs or is anticipated (headaches, nausea, stomachaches, vomiting)
  3. Most Common Fear for SAD
    getting lost
  4. Generalized Anxiety Disorder
    • Excessive and uncontrollable anxiety and worry about a number of events and activities
    • -High standards for self-achievement
    • -Require frequent reassurance
    • -Overestimate likelihood of negative consequences, exaggerate the predicted outcomes to a catastrophic degree, and underestimate their ability to cope with less than ideal circumstances
    • -Kids most likely to have psychosomatic symptoms
    • -slow to warm up is more likely to worry
    • -can become agitated with others
  5. Generalized Anxiety Disorder Criteria
    • A. Excessive anxiety and worry more days than not for 6+ months about a number of events/activities
    • B. Person finds worry difficult to control
    • C. 1+ sx for children:
    • -restlessness or feeling keyed up or on edge
    • -easily fatigued
    • -difficulty concentrating or mind going black
    • -irritable
    • -muscle tension
    • -sleep disturbance
  6. Panic Disorder Criteria
    • The occurrence of 1+ unexpected panic attacks followed by 1+ month of 1+ symptoms:
    • -Persistent fear of future attacks
    • -Worry about implications/consequences of the attack (losing control, having a heart attack, "going crazy")
    • -Significant change in behavior related to the attacks
    • With or Without the presence of Agoraphobia
  7. Panic Attack
    • A discrete period of intense fear/discomfort with 4+ symptoms developed abruptly and peak within 10 minutes:
    • -Palpitations, pounding heart, or accelerated HR
    • -Sweating, trembling, or shaking
    • -Sensations of shortness of breath or smothering
    • -Feeling of choking
    • -Chest pain or discomfort
    • -Nausea or abdominal distress
    • -Feel dizzy, unsteady, lightheaded, or faint
    • -Derealization or depersonalization
    • -Fear of losing control, going crazy, or dying
    • -Chills or hot flashes
  8. Most Frequent Panic Symptoms
    • Tachycardia
    • Nausea
    • Hot/Cold Flashes
    • Shaking/Jitteriness
    • Dizziness
    • Sweating
    • Dyspnea
    • Depersonalization, Derealization
    • Headaches
  9. Social Phobia
    • A. Fear of 1+ social or performance situations where the person fears embarrassment may occur (Children: evidence for capacity for age-appropriate social relationships with familiar people and anxiety must occur in peer settings, not just with adults)
    • B. Exposure provokes anxiety, sometimes panic attack (Children: anxiety may = crying, tantrums, freezing, or shrinking from social situations with unfamiliar people)
    • C. Children may not recognize fear as excessive/unreasonable
    • D. Social or performance situations are avoided or endured with intense anxiety or distress
    • E. Interferes with normal routine, occupational/academic functioning, or social activities or relationships, or there is marked distress about having the phobia
    • F. Under 18: duration 6+ months
  10. Social Phobia: Generalized
    • If fears involve most social situations
    • -Most common form in children and adolescents
  11. Those with Social Phobia
    • Often have few friends, reluctant with group activities, endorse feelings of loneliness (self-report), and are considered to be shy and quiet
    • In school they fear: reading aloud, speaking in class, asking for help, gym, group projects, tests, eating in the cafeteria
    • Excessive concerns about embarrassment, negative evaluation, and rejection
    • Complaints of stomachaches and illnesses common
  12. Specific Phobia Criteria
    • A. Marked/persistent fear of objects or situations
    • B. Provokes anxiety or panic attacks (Children: anxiety may = crying, tantrum, freezing, or clinging)
    • C. Children: may not recognize as excessive/unreasonable
    • D. Phobic situation avoided or else endured with anxiety/distress
    • E. Interferes with normal routine, occupation/academic functioning, social activities or relationships, or there is marked distress about having the phobia
    • F. Under 18: duration 6+ months
  13. Specific Phobia: Subtypes
    • Animal Type: cued by animals or insects
    • Natural Environment Type: storms, heights, darkness, water
    • Blood-Injection-Injury Type: seeing blood, injury, injections
    • Situational Type: public transportation, tunnels, bridges, elevators, flying, driving, or enclosed places
    • Other: situations that may lead to choking, vomiting, or contracting an illness Children: avoidance of loud sounds or costumed characters
  14. Common Phobias for Children
    • Heights
    • Darkness
    • Loud Noises (such as thunder)
    • Injections
    • Insects
    • Dogs
    • Other Small Animals
  15. Specific Phobia: Responses in Children
    • Cognitive: catastrophic predictions of a dreadful event occurring upon expsure to feared stimulus
    • Behavior: avoidance (screaming, crying, tantrums, or hiding in anticipation), when unavoidable (clinging or begging parents or help), apprehensive and hypervigilant for feared stimulus
    • Physiological: consistent with panic sensations- rapid HR, sweating, hyperventilating, shakiness, and upset stomach
  16. Specific Phobia: Common Co-morbid Features
    • Depression
    • Somatic Symptoms
  17. A Phobic Reaction is
    excessive and disproportionate, occurs without volition, leads to avoidance, persists over time, and is maladaptive
  18. Obsessive-Compulsive Disorder Criteria
    • A. Recurrent and intrusive obsessions and compulsions that are time-consuming (more than one hour per day) and either cause marked distress or significant impairment in functioning
    • B. Either Obsessions or Compulsions
  19. Obsessions
    • Recurrent and persistent thoughts, impulses, or images that are intrusive and inappropriate and cause anxiety and distress
    • Not about real-life problems
    • Person attempts to ignore, suppress, or neutralize them with other thoughts or actions
    • Recognize they are a product of his/her own mind
  20. Compulsions
    • Repetitive behavior that the person feels driven to perform in response to obsessions or according to rules that must be applied rigidly
    • Behaviors are aimed at preventing or reducing distress or dreaded event/situation
    • Behavior is not realistic to what they're designed to neutralize
  21. OCD can ______ other disorders
    • fuel
    • Eating Disorder: preoccupation with food
    • Hypochondriasis: preoccupation with illness
  22. Themes of OCD
    • Orderliness
    • Superstitiousness
    • Contamination
    • Cleanliness
    • Religiosity
  23. Types of Compulsions
    • Repetition
    • Washing
    • Checking
    • Ordering
    • Arranging
  24. 4 Components of Posttraumatic Stress Disorder
    • Exposure
    • Reexperience
    • Avoidance
    • Increased Arousal
  25. PTSD: Exposure
    Exposure to event- child response may be disorganized or agitated behavior
  26. PTSD: Reexperience
    • Repetitive play with themes from trauma
    • Frightening dreams without recognizable content
    • Trauma-specific reenactment
    • Distress at exposure to cues
    • Physiological reactivity at exposure to cues
  27. PTSD: Avoidance
    • Efforts to avoid thoughts, feeling, conversations, activities, places, people associated with trauma
    • Inability to recall important aspects of trauma
    • Detachment from others
    • Restricted range of effect
    • Sense foreshortened future
  28. PTSD: Increased Arousal
    • Difficulty falling or staying asleep
    • Irritability
    • Difficulty concentrating
    • Hypervigilance
    • Exaggerated startle response
  29. PTSD: Acute, Chronic, Delayed Onset
    • Acute < 3 months
    • Chronic > 3 months
    • Delayed Onset: onset 6+ months after trauma
  30. PTSD in Children
    • Dreams may be generalized nightmares of monsters, rescuing others, or threats to self or others
    • Young children don't usually have a sense that they are reliving the past- repetitive play
  31. Event + Overwhelmed =
    Perception that they can't function
  32. More Prone to Trauma
    • Trust Issues
    • Suspicious
    • Pessimistic
    • Higher chance for Anxiety Disorders
  33. Acute Stress Disorder
    2 days to 4 weeks
  34. Purpose of Play Therapy
    to regain mastery in the child's life
  35. Posttraumatic Play
    • Lack of spontaneity
    • Unconscious link between the play and the real event
    • Compulsive repetition
    • Literalness of play
    • Failure to relieve anxiety
    • Depiction of danger
    • No pleasure in play
  36. Appraisal
    meaning of event in terms of health/safety
  37. Beliefs
  38. Attributions
    child's self-perception following traumatic event
  39. Most Common PTSD Responses
    • Dissociation
    • Guilt
    • Generalized anxiety/fears
    • Low self-esteem
    • Omen formation
    • Depression
    • Separation anxiety
  40. Model of Traumatic Events: General Experience
    • death or injury to self or others
    • viewing wounded, bleeding persons or corpses
    • Suddent/unexpectedness of event
    • Duration and frequency of exposure
    • Adverse consequences are long-lasting or irreversable
  41. Model of Traumatic Events: Personal Impact on Child
    • child affected directly as opposed to as a group
    • perceived events as a personal threat
    • stigmitization associated with exposure to the event
  42. Model of Traumatic Events: Impact on Family
    • perceived events as threatening to family/friends
    • event originated within family
    • child was dislocated from the home
    • child was separated from family/friends
  43. Exposure to extreme stressors is associated with
    changes in brain structure and function among adults
  44. Major Depressive Disorder Criteria
    • 5+ sx for 2 weeks, at least one symptom is depressed mood or loss of interest/pleasure:
    • -depressed mood nearly every day (Children: irritable)
    • -diminished interest/pleasure in most or all activities nearly every day
    • -weight loss/gain (Children: failure to make expected weight gains)
    • -Insomnia/Hypersomnia
    • -Psychomotor agitation/retardation
    • -Loss of energy
    • -Feelings of worthlessness or excessive/inappropriate guilt
    • -Diminished ability to concentrate or indecisiveness
    • -Recurrent thoughts of death, suicidal ideation without a plan, or suicide attempt or specific plan
  45. Dysthymic Disorder Criteria
    • A. Depressed mood most of the day, more days than not for least 1 year
    • B. 2+ sx:
    • -poor appetite or overeating
    • -insomnia/hypersomnia
    • -low energy/fatigue
    • -low self-esteem
    • -poor concentration or indecisive
    • -feelings of hopelessness
    • C. During 1 year, person has never been with sx of A and B for more than 2 months at a time
    • D. No Major Depressive Episode during 1st year
    • E. No manic, mixed, or hypomanic episode
    • Early Onset < 21 years
    • Late Onset > 21 years
  46. Dysthymic Disorder characteristics and most common features
    • Sometimes presents as negative personality, irritable, apathetic, never satisfied
    • Most Common: low self-esteem, poor concentration/ indecisiveness, hopelessness, low energy
  47. Children more/as Depressed as Adults:
    • Developmental Limitations (emotional regulation, verbal expression of emotions)
    • Lack control with factors in life
    • Less coping skills
    • Executive functioning
    • Trouble with attachment
    • Concept of time isn't good
    • Maltreatment
    • Preexisting Conditions (ADHD, Anxiety, genetic predisposition)
  48. Depression in Children:
    • Older children, parallels with adults
    • Externalizing behavior may seem like disruptive behavior instead of depression
    • Children present as irritable
    • Anxiety, Disruptive Behavior, and Bipolar Disorder preceded Depression
  49. Models for Depression: Biological
    • having a parent with depression is one of the strongest predictive factors
    • especially with exposure to adverse conditions
  50. Models for Depression: Cognitive
    • role of negative and maladaptive belief systems in the onset and course of a disorder
    • Developmental Thinking + Mood (8yo- concrete thinking -I think therefore it's a fact)
    • Depressed children more likely to link negative things to themselves
    • Negative things are more stable
  51. Models for Depression: Behavioral
    • consequences of skill deficits and an ensuing inability to elicit positive feedback
    • negative feedback is internalized
  52. Models for Depression: Family
    • Loss as a primary vulnerability: either actual physical loss or symbolic loss (emotional deprivation, rejection, or inadequate parenting)
    • Attachment Theory
  53. Models for Depression: Life Stress
    • Diathesis-Stress Model: view depression as a function of the interaction between personal vulnerability and external stress
    • Biological Tendency + Environmental Stressors
  54. BD does not resemble Adult BD:
    • No acute onset of episodes
    • No periods of relatively good functioning
    • No distinct episodes of elevated mood/irritability
  55. BD Parents:
    scared, anxious, walking on eggshells
  56. BD symptoms overlap with ______
  57. Rage
    fused mania and depression
  58. Especially at Risk for BD:
    • Severe depression (especially if psychotic)
    • Family history of BD
    • Develop hypomania in response to antidepressants
  59. Prominent Features of BD
    • Irritability
    • Rage
    • Aggression
  60. Adolescent with BD have a higher chance of ______
    • substance abuse
    • Stimulants and Depressants
  61. Manic Episode Criteria
    • A. 1+ week with persistent elevated, expansive, or irritable mood
    • B. 3+ sx:
    • -inflated self-esteem/gradiosity
    • -decreased need for sleep
    • -more talkative than usual/pressured speech
    • -flight of ideas
    • -distractibility
    • -increase in goal-directed activity/psychomotor agitation
    • -excessive involvement in pleasurable activities with high potential for painful consequences
  62. GAD: Frequent Reported Worries
    • tests/grades
    • natural disasters
    • being physically attacked
    • future academics
    • being bullied by peers
    • adult concerns- family finances
    • performance in school, athletics, social relationships
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Child & Adolescent Psychopathology Exam 2
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