Clinical Child Psych Test 4

1. DIAGNOSTIC CRITERIA
   1. A. Fear of social situations where they might be judged, observed, or must perform in front of others
   2. B.Fear that they will be embarrassed and rejected
   3. C. The social situations almost always provoke fear or anxiety
      1. expressed by crying, tantrums, freezing, clinging, shrinking, or failing to socially speak
   4. D. Social situations avoided or endured with intense anxiety
   5. E. Fear or anxiety is out of proportion
   6. F. Fear/ anxiety/ avoidance lasts 6 months or longer, usually
   7. G. Anxiety causes setbacks in functioning
   8. H. Not attributable to any substance
   9. I. Not another mental disorder for sure
   10. J. Fear/ anxiety unrelated if the person has medical conditions
2. Child can speak but refuses to speak or speaks quietly, caused by fear or embarrassment
3. Can be limited to performance situations only
   1. Treatment: exposure, knowledge through experience
4. FEARS

   Nota:

   • Side note: you are most likely to perform well if you are not thinking about others watching you, it was just automatic
   1. Reading aloud
   2. Performance activities
   3. Eating with others
   4. Etc, but all this stuff happens all the time
5. SOURCE --> inhibition system
   1. Over-controlling/protective parents

Nota:

• This should actually be under "Anxiety and OCD"

1. DIAGNOSTIC CRITERIA
   1. Panic attacks reach their peak within 10 mins
   2. 4 plus symptoms occur
      1. Heart irregularities, sweating, trembling, can't breath, chest pain, nausea, dizzy or light-headed, chills/heat flashes, numbness/tingling, feels surreal, fear of losing control or dying
   3. And one of these two happens for the next month or more
      1. Fear of 2+ of these
         1. Public transportation
         2. Open spaces
         3. Enclosed spaces
         4. Standing in line / crowds
         5. Being away from home alone
         6. (THESE ARE SYMPS OF AGORAPHOBIA, which is not the same as PD
         7. How might agoraphobia develop in terms of panic disorder?
            1. Negatively reinforced by avoiding situations in which they might have a panic attack
      2. Must be able to escape or be helped in a situation, in case they have a panic attack
      3. Agoraphobia
      4. Fear is excessive
      5. Persists for 6 months
      6. For sure to another mental disorder
2. You can have a panic attack without having panic disorder
   1. 1/3 of adults // 1/10 of children
3. TYPES OF PANIC ATTACKS
   1. Type A: Calm>PANIC>Calm
      1. (Probs not PD yet)
   2. Type B: Calm>PANIC>Anxious
   3. Type C: Anxious>PANIC>Calm
4. It becomes panic disorder when you start to fear panic attacks happening again

1. "kiddo" that worries about everything
2. SYMPTOMS
   1. Tension, Apprehensive expectations, negative self-image, need for reassurance, irritability, physical complaints, concentration problems, brooding, fatigue, psychomotor agitation, sleep problems
3. THINGS THEY WORRY ABOUT THE MOST IN ORDER
   1. Health of others
   2. Family matters
   3. The little things
   4. School
   5. Self health
4. Reassurance seeking > negative reinforcement rapidly throughout the day
5. Internalizing Symptoms
   1. Anxious-Misery Symptoms (last a long time)
      1. Major Depressive Disorder
      2. Dysthymic Disorder
      3. GAD
   2. Fear Symptoms (symptoms occur abruptly and then go away and may only occur in certain situations)
      1. Specific Phobia
      2. Social Phobia
      3. Agoraphobia
      4. Panic Disorder
6. Worrying + Problem Solving = Normal
7. Worrying + Rumination = GAD
   1. (rumination is usually past oriented)

1. Compulsion: ex-washing/grooming
   1. Repetitive behaviors/thoughts to prevent anxiety or a dreaded event--won't realistically prevent or neutralize anything
   2. but the compulsion doesn't have to fix the obsession in a sensible way
2. Obsession: ex-germs
   1. often related to religion or sexual imagery
   2. 1. Persistent thoughts, urges, images that come as intrusive thoughts and cause anxiety
   3. 2. Attempts to ignore the thoughts and to neutralize them with another thought/action
3. trying to ignore an intrusive thought = a compulsion
4. DIAGNOSTIC CRITERIA
   1. A The presence of obsessions, compulsions, or both:
   2. B. Time consuming / Impairs functioning
   3. C. Not the result of drugs
   4. D. For sure not another mental disorder
5. Classifying OCD
   1. With good or fair insight
      1. realizes beliefs are probe not true
   2. With poor insight:
      1. Thinks beliefs are probe true
   3. With absent insight:
      1. Completely convinced of beliefs
   4. Tic-related:
      1. history of tic disorder
6. Comorbidity with ASD
7. Disregulation of the cortico-stratial-thalamic circuit

1. Well-learned tasks are performed better in front of an audience
2. Poorly learned tasks are performed even more poorly
3. FEAR Plan
4. CBT for Parent and Child is the most effective treatment
5. CBT and Sertraline (meds) do not work as well to relieve anxiety alone as they do together, but anything is better that a placebo

1. DIAGNOSTIC CRITERIA (2+ primary criterion)
   1. Behavioral
   2. Cognitive
      1. Intrusion Symptoms - one or more
         1. Distressing memories
         2. Distressing dreams
         3. Flashbacks
         4. Physiological reactions to internal cues
   3. emotional
   4. physiological
      1. Alterations in arousal and reactivity
         1. Angry outbursts
         2. Reckless/self-destructive
         3. Hypervigillance
         4. Exaggerated startle response
         5. Concentration Probs
         6. Sleep disturbances
   5. trauma
      1. sexual trauma
      2. REQUIRED for PTSD diagnosis
   6. Exposure - one or more
      1. Direct experience
      2. Witnessing
      3. Learning about event involving fan member / friend
      4. Repeated exposure to details
         1. Internal or external cues cause distress
      5. Children are more likely to have PTSD symptoms/ PTSD if they are directly exposed to a traumatic event (>indirect>no exposure)
   7. Persistent Avoidance
   8. Negative alterations in cognitions and mood
      1. Amnesia
      2. Negative beliefs about oneself, others, or the world
         1. Detachment from others
      3. Blaming oneself
      4. Negative emotional state
      5. Lack of interest in activities
      6. Inability to be happy
   9. Duration of disturbance > 1 month
   10. Disrupts normal functioning
2. Critical Incidence Stress Debriefing > not helpful
3. not due to substance or medical condition
4. Cortisol reduces the size of the hippocampus in large qualities (depression)

1. Definition
   1. Harm Standard:failure to act on the part of caregiver, results in death/physical/emotional harm/sexual abuse/exploitation
   2. Endangerment Standard: act/failure to act that presents risk of serious harm
2. Symptoms in order of how common they are
   1. Avoidance of people/places
   2. Irritability and tantrums
   3. Sleep disturbance/Distress from reminders
3. GENERAL MALTREATMENT STATISTICS
   1. Over 900,000 children victims of maltreatment in 2006
   2. 12.1 per 1000 children in general population
   3. Nearly 3.6 million received investigation
4. CHARACTERISTICS OF FAM / PERPETRATOR
   1. Low SES
   2. Single parent / large household
   3. Parents - 85%
   4. Sexual abuse: 50% parents, 50% not
   5. Neglect: 90% mothers

1. Spurning - reject/degrade child
2. Terrorizing - threatening
3. Isolating - no interaction w peers
4. Exploiting - encourage antisocial acts, transport drugs, porn, prostitution
5. Denying emotional responsiveness
6. Health and educational neglect

1. Any maltreatment
   1. Physical Abuse
      1. toddlers, preschoolers, young adults, boys=girls
2. Neglect
   1. children 1-3
3. Sexual abuse
   1. 12 or older, 80% girls
4. Psychological abuse
   1. toddlers, preschoolers, young adults

1. Cannot coexist with ODD or bipolar disorder--if they are diagnosed with both, they really just have DMDD
2. are more likely to develop depression (1.3-1.8 times more likely) or anxiety (1.7), but not bipolar disorder
3. More activity in Anterior Cingulate Cortex and Medial Frontal Gyrus
4. Risperdall seems to treat it, but there was no control group

1. labeled praise
2. Reflection / praise
3. Immitation
4. Description
5. Enthusiasm

1. survey options
2. brainstorm solution
3. Evaluate Choices
4. Select one
5. Impliment it
6. Monitor outcome

1. symptoms must last for at least 2 weeks
   1. There has never been a manic/hypomanic episode
   2. Disrupts regular functioning
2. Must have 5 of these symptoms
   1. ANHEDONIA- absence of seeking pleasure
   2. irritable/sad mood nearly every day, most of the day
   3. weight or eating disregularity
   4. sleeping probe nearly every day
   5. noticeably restless or slow
   6. Worthlessness / guilt
   7. Fatigue
   8. hard time concentrating
   9. thoughts of death
3. Categorizing it...
   1. Single episode: situational depression
   2. Recurrent: 2+ depressive episodes with 2 month in between
   3. Mild: few and mild symptoms
   4. Severe: a lot of severe symptoms
4. DSM IV -- if you recently lost a loved one, you don't have depression
5. DSM V -- you can be diagnosed with depression (self-fulfilling prophecy)
6. Cognitions that contribute to depression
   1. Catastrophizing - expecting something bad to happen
   2. Overgeneralization - thinking because one situation happens, it applies to all situations
      1. ex: he broke up with me, I will always be single
   3. Dichotomus thinking - something is either all good or all bad
   4. Mind reading- or thinking you can
   5. Personalization - taking responsibility for something that's not your fault
   6. Absolute thinking - "I must" "I should" "I have to"
7. People with depression have the most Personal Failure Automatic Thoughts (then anxiety, behavior problems)
8. Treatment: Prozac, but the best treatment is CBT only and CBT is more effective over the long term
9. Tricyclics are not effective
10. SSRI's increase suicidal ideation and are less effective over time

1. Manic Episode (BIPOLAR 1)
   1. must have 3 or more of these symptoms and last one week
      1. inflated self-esteem
      2. no need for sleep
      3. talkative
      4. racing thoughts
      5. distractibility
      6. goal oriented
      7. activities with consequences
   2. usually lasts 1-4 weeks
2. Hypomanic Episode (BIPOLAR 2)
   1. about 4 days
   2. slightly better than Manic Episodes, because they don't last as long
3. Cyclothymic Disorder
   1. 2 symptoms of mania / hypomania, 3 symptoms of depression, for 2 years
   2. Can't go without symptoms for 2 months
4. 70% thoughts of death
5. and just read the slides after this....