-fear of 1 or more social/performance situations where person is exposed to unfamiliar people

-person fears they will act in humiliating/embarassing way.

-exposure to feared social situations provokes anxiety (may be panic attacks)

-recognizes fear is excessive and unreasonable

-social situations are avoided or endured w/intense anxiety

-age of onset is mid adolescence (rare in under 10)

-occurs in 1-3% of children (more girls than boys)

-66% have another anxiety disorder

-selective mutism may be symptom

-recurrent, time-consuming, disturbing obsessions that cause anxiety

-often accompanied by compulsions performed to relieve anxiety

-no longterm relief--disrupts social life

-occurs in 2-3% of children--onset is late childhood

-treatment is exposure and response prevention

-medication=Luvox

-recurrent unexpected panic attacks

-persistent concern about implications/consequences of having another attack

-must be worried afterwards

-can lead to agoraphobia(dont want to be alone)

-age of onset is 15-19

-panic attacks common (3-4% of teens)

-worst of all disorders but easily treated

-persistent anxiety following an overwhelming traumatic event that is outside the range of usual experience

-re-experiencing of traumatic event

-avoidance of associated stimuli and a numbing of general responsiveness

-symptoms of extreme arousal

-development of dissociative symptoms

-most occur within 1 month after exposure to an extreme traumatic stressor

-lasts at least 2 days and not more than 1 month

-extreme and disabling fear of particular objects or situations that pose little or no danger

-may be situationally bound or predisposed (crying,tantrums,freezing,clinging)

-person recognizes fear is excessive (not necessarily in children)

-leads to avoidance in normal routines

-evolutionary theory

-occurs 2-4% of all children

-more common in girls

1.animal-most common is dogs, snakes, mice, insects

2.blood-injection, injury (seeing blood), medical procedures

3.natural environment-heights, darkness, storms, water

4.situational-flying, elevators, tunnels, bridges, driving

5.other-doesnt fit cleanly

TREATMENT

1. graded exposure-gradual

2.systematic desensitization-teach relaxation, fear, hierarchy, present and practice

3.floooding-prolonged and repeated

4.response prevention-not allowing escape or avoidance

-excessive and uncontrolled anxiety about a number of events/activites more days than not

-must last at least 6 months

-person finds it difficult to control the worry

-anxiety is associated with 1 of the following

1.restlessness or feeling keyed up or on edge

2.being easily fatigued

3.difficulty concentrating/mind going blank

4.irritability

5.muscle tension

6.sleep disturbance

Generalized Anxiety Disorder

Coping Cat

-may serve to reinforce behavioral avoidance

-occurs in 3-6% of children

-equal rates in boys and girls

-high rates of other anxiety disorders and depression

-onset in late children or early adolescence (10-14)

-highly comorbid

-age-inappropriate, excessive, and disabling anxiety about being apart from parents or away from home

-normal for preschool age; inappropriate at age 7

DSM criteria

-excessive distress when separated from major attachment figures

-excessive worry about losing or harm occuring to major attachment figures

-excessive worry that untoward event will lead to separation from major attachment figures

-presistent reluctance or refusal to go to school bc of fear of separation

-most common child anxiety disorder--10%

-most common among girls

-onset may be chronic or sudden

-highly comorbid with other anxiety disorders

TREATMENT

-exposure:systemaatic desensitization; flooding

-make kids go to school!

-many fears are developmentally appropriate and decline with age

-anxieties are also common but do not show age-related decline

-older children report a greater variety and complexity of worries

-ritualistic and repetitive activity is very common and helps them to gain control and mastery over their environments

-anxiety: future-oriented emotion characterized by feelings of apprehension about upcoming events

-fear:present-oriented emotion reaction to

-panic: UNEXPECTED and sudden fight/flight response in the absence of danger

1.physical: perceive danger, brain sends messages to sympathetic nervous system; fight/flight response; chemical and physical effects that ready the body for actions

2.cognitive: seraching for potential sources of threat; difficulty focusing on every day tasks

3.behavioral: aggression and/or desire to escape 

-a mood state characterized by strong negative emotions and bodily symptoms

-anticipation of future danger or misfortune

-children can experience excessive and debilitating anxiety--this is a disorder

-in moderate amounts, anxiety is an adaptive emotion that readies children for coping with situations

-only 1 anxiety disorder (separation anxiety disorder) is written w/ children in mind.. All others were written for adults.

-problem with this:

anxiety looks different in kids

being scared is normal

usually goes away

-an absence of effective interventions

-if not treated early, prognosis is poor

-types of interventions

parent management training (PMT)

cognitive problem-solving skills training (PSST)

multisystemic treatment (MST)

medication

Causes of CD and ODD

Genetic Influence

-biologically based traits

-adoption & twin studies

-reward dominance theory: (related to dopamine)

      reward deficiency syndrome

Causes of CD and ODD

Neurobiological Factors

-behavioral activation system (BAS) vs behavioral inhibition system (BIS)

-psychophysiological arousal

-neurodevelopmental risk factors

     exposure to lead

     brain structure

Causes of CD and ODD

Social-Cognitive Factors

-immature thinking

    egocentrism

    lack of perspective taking

-cognitive deficiencies

    failure to use verbal mediators to regulate behaviors

-cognitive distortions

    interpreting neutral events as hostile

-deficits in information processing

Causes of CD and ODD

Family

-coercion theory

    reinforcement theory--reinforcment trap

-attachment theories

-family instability and stress

-parental criminality and psychopathology

*parent and child interactions provide child with how to interact with people

Causes of CD and ODD

Society

-neighborhood

   criminal subculture/social selection

   frequent transitions and mobility

   low social support from  neighbors

-school

   quality associated with delinquency

-media

   exposure to violence as reinforcement

1. genetic influences
2. neurobiological factors
3. social-cognitive factors
4. family
5. society

-ADHD: 50% of those w/ CD also have ADHD

-Depressioin and Anxiety: 1/3 also have mood or anxiety disorder

-ODD -> CD -> Antisocial Personality Disorder

-ODD -> no diagnosis -> doesnt start with CD

Course of Disruptive Behavior

life-course persistent path

-life-course persistent path

• begins at an early age & constinues throughout adulthood
• complete recovery is rare
• family history of antisocial behavior

Course of Disruptive Behavior

Adolescent-limited path

-Adolescent-limited path

• begins at puberty but disappears by adulthood
• more common & less serious
• peer influenced
• characterized by boundary testing in adolescence

Prevalence rate for CD and ODD

-CD: 2-6%                                          -ODD: 12%

Gender impact

-Childhood: 3-4 times more common in boys

-lifetime prevalence for girls is 3%

-sex differences in adolescence disappear

6 domains of characteristics of CD & ODD

1. cognitive and verbal deficits
2. school and learning problems
3. self-esteem problems
4. peer problems
5. family problems
6. health-related problems

Onset of CD

Childhood onset

-display 1 characteristic before age 10

-most likely to be boys

-aggression and illegal activity are prominent

-antisocial behavior persist

Onset of CD

Adolescent onset

-equal number of boys and girls

-less severe than childhood onset

-less likely to be violent

-antisocial behaviors less likely to persist as they get older

Disruptive Behavior Disorder

ODD

-pattern of defiant behavior lasting at least 6 mos, during which 4 (or more) of the following are present:

often loses temper

argues w/ adults

refuses to comply w/adults' rules

deliberately annoys people

blames others for their mistakes

touchy or easily annoyed by others

angry and resentful

spiteful or vindictive

Disruptive Behavior Disorder

CD

-repetitive and presistent behavior where basic rights of others or major societal norms or rules are violated

-must have 3 or more symptoms in the past 12 mos & at least 1 in the past 6 mos:

bullies, threatens, or intimidates others

initiates physical fights

uses weapons for harm

physically cruel

stolen while confronting a victim

forced someone into sexual activity

-clinically significant impairment in functioning

-criteria not met for antisocial personality disorder if 18 or older

-disordered behavior is defined as delinquent or criminal acts that result in arrest and court contact

-age of responsibility in most states is 12 yrs old

-only a subgroup of children who meet legal definitions will have the disorder

1. normal in children

2. vary in severity

3. decrease over time (exception of aggression)

4. more common in boys (difference gone by adolescence

-antisocial behavior is the most costly mental health problem in North America

-disordered behavior occurs in 5% of children

   these children account for 50% of US crimes

   represent 1/3 of all clinic referals

-age inappropriate actions that violate family expectations, societal norms, and teh personal or property rights of others

-the types, causes, and outcomes are varied; thus, there are different developmental pathways

-children w/ disruptive behavior disorders often grow up in extremely unfortunate family and neighborhoods

-focus on managing inattentive and hyperactive implusive behaviors that interfere w/learning

-provides classroom environment that capitalizes on child's strengths and improves academic performance

-teach prosocial and sel regulating behaviors

-provides parents w/ a variety of skills to help them manage their child's oppositional/non compliant behavior

-reduce parent-child conflict

-cope with the difficulties of raising a child w/ ADHD

-stimulant medications are the most effective treatment

-most common are Dextromphetamine and Methylphenidate

-alter activity in the frontostriatal brain region by affecting neurotransmitters

-operational defiant disorder: 50% mostly boys

-conduct disorder: 30-50% eventually develop

-anxiety disorder: 25% usually younger boys; reduced or eliminated in adolescence

-depression: 20-30%; likelihood of developing mood disorder increases by early adulthood

-3-5% of school aged children (onset by school age)

-3x more likely in boys

-more prevalent in low SES groups

-found in all cultures

-hyperactivity/impulsivity appears first

-deficits in attn increase as school demands increase

-oppositional and social aggression develop in 40-70%

-problems continue into adulthood

Family Interactions

ADHD and diet

child behavior prob -> family probs -> more child behavior prob -> more family probs

-diet has no link to ADHD

-strong evidence exists that ADHD is largely a neurobiological disorder

-abnormalities found in frontostriatal region of the brain and in pathways connecting this area to limbic system and cerebellum

-neuroimaging studies: structural differences or less activity in certain regions of the brain

-pregnancy and birth complications

-low birth weight

-malnutrition

-early neurological trauma

-maternal substance abuse

-runs in fmailies; more heritable than height

-siblings: adoptions studies--genetics acct for 50% of variance in attn problem scores

-twins: heritability is estimated to be .80

-role of dopamine

ADHD deficits

Theoretical Perspectives

-motovational deficits: diminished sensitivity to rewards and punishment, resulting in deterioration or performance when rewards are infrequent.

-arosal level deficits: (usually too low) resulting in excessive self-stimulation (hyperactivity) in order to maintain an optimal level of arousal

-self-regulation deficits: (the use of thought & language to direct behavior), resulting in impulsivity, poor maintenance of effort, deficient modulation of arousal level, and attraction to immediate rewards

-behavioral inhibition deficits: a core deficit that is the basis for the many cognitive, language, and motor difficulties of children with ADHD

Family

-noncompliance, negative interactions, maternal depression, paternal antisocial behavior, high parental control

Peers

-sociall insensitive, loud, socially aggressive, inappropriate, annoying

Medical/Physical Problems

w/ ADHD

-a link bt ADHD and upper respiratory problems is NOT supported

-sleep disturbances

-risky behavior

-prone to accidents
-higher risk for PTSD

Speech and Language Impairments

w/ ADHD

-occur in about 30-60% of children w/ ADHD

-have difficulty using language in daily situations:

   excessive talking, shifts in convo, interrupting

Cognitive Deficits

w/ ADHD

1. Executive functioning
2. intellectual ability
3. academic functioning
4. learning disorders

Cognitive Deficits

Executive Functioning

-high ordered mental processes that underlie the child's capacity for self-regulation, self-awareness, planning, self monitoring, and self-evaluation

--cognitive process: working memory, planning, mental computation

--language process: verbal fluency, use of self directed speech

--motor process: motor coordination, response inhibitioin

--emotional process: self-regulation of emotional arousal

Cognitive Deficits

Intellectual Stenghts & Deficits

-most children with ADHD are of at least normal overall intelligence

-difficulty applying their intelligence

Cognitive Deficits

Academic Difficulties

-lower academic productivity

-lower grades, failure to advance in grade level

-more frequent placements in special education classes

-failure to complete high school

Cognitive Deficits

Learning Disorders

-

Predominately inattentive vs. predominately hyperactive/impulsive

ADHD

-predominately inattentive: less common; comorbid w/ learning disorders and anxiety; slow processing speed and retrieval

-predominately hyperactive/impulsive: associated w/ aggression, defiance, peer rejection, and special education placement

Limitations of DSM

-not really developmentally sensitive

-problems w/ categorizing bc it is so detrimental

-before age 7 is iffy criteria

-a specific marker of the disorder

-defined as excessively energetic, intense, inappropriate, and not goal directed

BEHAVIORAL MANIFESTATIONS

-excessive talking

-acts as if "driven by motor"

-fidgety

-difficulty waiting one's turn

-interrupting

-6 or more symptoms of either inattention, hyperactivity/impulsivity or both

-symptoms present before age 7

-impairment from the symptoms present in 2 or more settings

-clear evidence of clinically significant impairment in social, academic, or occupational functioning

3 types of inattention

1. attentional capacity: amount of information we can remember and attend to for a short time (phone #)
2. selective attention: the ability to concentrate on relevant simuli and not be distracted by noise in the environment
3. sustained attention: the ability to maintain a persistent focus over time or when fatigued

-blurts out answers before questions have been completed

-has difficulty awaiting turn

-interrupts or intrudes on others

-fidgets w/ hands or feet or squirms in seat

--leaves seat in classroom or in other situations in which remaining seated is expected

-runs about or climbs excessively in situations in which it is inappropriate

-difficulty playing or engaging in leisure activities quietly

-often "on the go" or often acts as if "driven by a motor"

-talks excessively

-fails to give close attention to details or makes careless mistakes

-difficulty sustaining attention

-does not seem to listen

-does not follow through on instructions and fails to finish important tasks

-difficulty organizing tasks and activities

-avoids tasks that require sustained mental effort

-losses things necessary for tasks or activities

-easily distracted by extraneous stimuli

-often forgetful in daily activities

-no distinct physical symptoms; must look at the characteristic patterns of behavior