• problematic eating habits and limited food preferences are common in early childhood (picky eater)
• 1/3 of young children described as "picky"
• societal norms and expectations affect girls more than boys
• parent-child relationship is a factor
• around age 9 girls are more anxious then boys about weight

what are some developmental risk factors for eating disorders?

• binging pickyness
• eating habits are stable over time and predict later eating problems
• early childhood pica is related to later onset of bulimia
• picky eating and digestive problems are rish factors for anorexia

• sudden or marked deceleration of weight gain in an infant or a young child (under age 6) and slowing or disruption of emotional and social development
• can lead to physical and mental retardation and even death
• affect ~1/3 of children
• equally common amoung boys and girls
• onset in first two years of life
• many interacting risk factrs may result in failure to thrive
• no medical reason, then poor caregiving or neglect are likely causes
• mothers who have history of disturbed eating habits/attitudes
• family disadvantage, poverty, social isolation and parental mental illness

• ingestion of inedible substances
• affects very young children and those with M.R.
• if last longer then 1 month, may have serious problem (lead poisoning)
• attributted to poor stimulation and poor supervision
• vitamine defincency
• not genetic
• Tx= watch child more closely

What is failure to thrive? What are causes and risk factors?

• weight below the 5th percentile for age and/or deceleration for at least 2 SDs in the rate of weight gain from birth to present
• causes are debated: lack of maternal love -> emotional misery -> developmental delays -> physiological changes
• may be biological outcome of abuse and neglect
• better home environment, less like the child will have this

• defined as a chronic medical condition characterized by excessive body fat
• body mass index is above the 95th percentile
• prevalence rates are increasing (3-5% higher)
• preadolescent obesity is a risk factor for later eating disorders, especially for girls
• genetic prediposition
• improber diets
• unhealthy lifestyle- fast food
• family influences (poor communication, lack of support, maltreatment)
• family disorganization

• refusal to maintain a minimally normal body weight
• intense fear of gaining weight
• significant disturbance in perception of body size
• amenorrhea (no period)
• denial of thinness
• subtypes (restricting, binge-eating/purging)

• recurrent episodes of binge eating
• after binging, compensation for food intake by either purging or other forms
• often retain or gain weight
• 2 subtypes (purging, non-purging)
• not usually planned

prevalence and course

•  
  • anorexia: .5-1%
    • onset occurs between 14 and 18 years usually after a stressful life event
    • 50% show full recovery
    • 6-10% die from medical complications/ suicide
  • bulimia: 1-3%
    • onset occurs in late adolescence usually after a period of strict dieting
    • 50-70% show full recovery
  • far more common amoung females
  • anorexia occurs worldwide; bulimis is culture bound (high SES)
• Causes
  • biological (genetic contributions and serotonin)
  • social
    • physical appearance related to happiness, self-worth, and success (esp in Western cultures)
    • dieting is very much a part of the Western culture
    • Sex role identification and conformity
    • family dysfunction
  • psychological causes
    • struggle for autonomy, ompetence, control, self-respect
    • phobic avoidance of normal adult body weight and shape
    • affective (mood) disturbance 80% for anorexia
    • 90% have anothis Axis I disorder such as depression, anxiety, OCD like traits
• Treatment
  • hospitalization
  • antidepressants for bulimia
  • psychological interventions more effective then just medication
  • family-based interventions (anorexia)
  • cognitive-behavioral strategies (bulimia)

• early 1970's- child maltreatment recognized as significant problems
  • 1 in 12 children are sexually victimized
  • 1 in 10 children recieve harsh physical punishment
• child maltreatment refers to 4 primary acts
  • physical abuse, neglect, sexual-abuse, emotional abuse
• non-accidental trauma: effects of maltreatment on child's physical and emotional development
• victimization: abuse/ mistreatment of vulnerable populations (includes children, elderly, mentally handicap)

• children require balence between need for control and need for responsiveness
• healthy parenting involves:
  • knowledge of child development
  • adequate coping skills
  • normal parent-child attachment
  • home management skills
  • shared parenting responsibilities
  • providing social and health services (getting kids involved)

what does a child's response to stress depend on?

• child maltreatment: on of the worst forms of stress
• children's response to stress depends on the degree of support they recieve from their parents

healthy/ centered child <---------------> abusive/neglect

       (spanking)

• spanking is considerend somewhere in the middle between having a healthy child and abusing your child.

On what axes of the DSM might maltreatment be noted?

• maltreatment is not a form of abnormal child behavior nor is it a psychological disorder
• may be considered on:
  • axis 1: (depression, anxiety)
  • axis 4
• required to be put on an axis and report it

define physical abuse, three forms of neglect, sexual abuse, and emotional abuse

• physical abuse: multiple acts of aggression
• 3 forms of neglect:
  • physical: not seeking health care, expulsion from the hoe, abandonment, inadequate supervision
  • educational: allowing truancy., not enrolling child in school, not attending to child's special needs
  • emotional: inattention to child's needs for affection, failure to provide psychological care, spousal abuse in child's presence, permitting child to use illicit substances
• sexual abuse: can affect behavioral development/health
• emotional abuse: repeated acts/ommisions that may cause serious behavioral, cognitive, emotional, or mental disorders (just as harmful as neglect)

• of documented maltreatment cases:
  • 64% involve neglect
  • 16% involve physical abuse
  • 9% involve sexual abuse
• sexual abuse: females > males
• physical abuse: males >females

• age: younger children more at risk for abuse and neglect (exception: sexual abuse more common amoung older age groups >12)
• sex: boys and girls are victims of maltreatment almost equally (exception: females more likely to be victims of sexual abuse)
• race: maltreatment most common amoung Caucasions, then African-Americans, then Hispanics

• children of low SES, single-parent, and large families at highest risk of maltreatment
• 80% of victims abused by one or both parents
• 50% of sexually abused children are abused by persons other then parents
• mother is perpetrator of neglect 90% of time
• males are offenders in majority of sexual abuse cases 90% (50% of the time it is the father or father figure)
• most common perpetrator for child maltreatment is a female parent acting alone.

• developmental course
  • resiliance and adaption
    • maltreatment does not affect each chils in predictable way
    • protective factors
      • positive relationship with one important and consistent person
      • personality characteristics: positive self-esteem and sense of self
• developmental consequences
  • early attachment and emotion regulation
    • exhibit insecure-disorganized attachment
      • difficulties with understanding, labeling, and regulating internal emotional states
  • brain development
    • HPA axis and norepenephrine systems
    • ther implicated brain areas: hippocampus, prefrontal cortex, amygdala
    • neuroendocrine systems
  • emerging view of self and others
    • develop negative representational models of self based on sense of self-blame, shame, or rage
  • emotional and behavioral problems
    • physically abused children tend to be more physically and verbally aggressive, unpopular and rejected
    • neglected children often withdraw from and avoid peer interaction
    • sexualy abused children may show sexualized behavior, symptoms of depression and anxiety

• child maltreatment can lead to a host of chronic psychiatric disorders
• depression, emotional distress, and suicidal ideation are common
• child sexual abuse can lead to impairments in self-esteem, self-concept, and emotional/behavioral self-regulation
• significant connection exists between maltreatment and violence
• cycle of violence hypothesis (if you are treated violently as a child, then you will be violent as an adult)

• maltreatment usually occurs during stressful role transitions for parents, times of familial instability and developmental periods of testing limits

• stress is among on of the multiple causes
• not typically caused by adult psychopathology
• physical abuse and neglect
  • offender characteristics
  • information processing deficits, inadequate knowledge of children's needs, disengagement under stress, and ineffective coping skills
• child and family influences
  • no child characteristics linked to risk of maltreatment
  • coersive family interactions
• sexual abuse
  • offender characteristics
  • mixed group- most meet DSM criteria for pedophilia
  • comorbid psychiatric disorders and substance abuse
  • own history of abuse

• physical abuse and neglect
  • teach parents how to properly discipline and attend to their child
  • CBT
• sexual abuse
  • assist children in understanding why they were victimized and ways to keep them safe

• persist for more than 3 months or requires hospitalization for more than 1 month

• somataform disorder: involve physical symptoms that resemble or suggest a medical condition, but lack organic or physiological evidence
• psychological factor affecting a physical condition: psychological factors are presumed to cause or exacerbate a physical condition

How can adjustment disorder be related to chronic illness?

• chronic illness can be accompanied bu significant adjustment or behavior problems (adjustment disorder)

• great progress in terms of developing treatments
• led to greater child and adult morbidity
• focus on promoting children's health and developments and assisting in the care of those with chronic illness.

• children experience pain just like adults
• children may use pain for secondary gainst
• children may express fears, dislikes, and avoidance through somatic complaints
• girls report more symptoms of pain and anxiety than boys
• family influences can shape how children express pain and related symptoms
• chromic health disorders and conditions affect 10-20% of children
• asthma most common chronic illness in childhood
• social class and ethnicity have no influence on who is affected by chronic illness
• children of low ses have lower survival rates

What are the symptoms, associated characteristics, gender differences, and treatments for diabetes in children?

• lifelong metabolic disorder where body cannot metabolize carbohydrates because of inadequate release of insulin
• associated with significant mortality
• no gender differences
• rates of the disease are increasing
• mental health treatment= behavioral strategy

with regard to childhood cancer, what is the onset like compared with adults?

• onset is more sudden and diseasemore advanced in children when first diagnosed.

what is the most common form of childhood cancer?

What is the treatment for childhood cancer? What about the mortaility rate and associated adult outcomes?

• requires intensive medical treatment, especially during the first 2-3 years
• 80% of pediatric cancer patients survive
• 50% will have serious physical or mental illnes as adults

Discuss the development and course of childhood cancer?

• children with chronic illness have 2.4 times higher risk for pediatric disorder than healthy children (primarily internalizing disorders)
• most children adapt successfully to their illness and show consideerble resilience
• some children with chronic illness may demonstrate social adjustment and academic problems

• Chronic illness suffered by a child may result in PTSD in family members
• Percieved social support and parental adjustment important for helping children lower stress and increase coping

siblings of children with chronic illness may exhibit heightened social and mental health problems

• adjustment defined in terms of psychological distress and through developmental accomplishments in social and school performance
• peer support important for adaptation and health-promoting behaviors
• social adjustments problems linked to CNS illnesses
• problems with school adjustment and performance may stem from effects of illness, treatment or secondary consequences
• 50% of children with brain-related illnesses are in special education settings

What does the biopsychosocial model say about childhood cancer?

• illness parameters: type of illness, severity and functional impairment
• demographic parameters: gender, age, and SES
• personal characteristics: age, age of onset, IQ, coping skills
• family characterisics: stress management, coping strategies, degree of support, and availability of resources.

what are some interventions for childhood cancer?

• psychosocial interventions
• family support groups
• treatment related activities based on needs of the family
• educational programs
• training in coping skills
• parent involvement and maternal adaptation are key to children's coping