Shared Flashcard Set


Abnormal Child Psychology
Exam 3
Undergraduate 4

Additional Psychology Flashcards




Physical Symptoms of Anxiety
  • perceived sense of danger and sends messages to the sympathetic nervous system; fight/flight response- ready body for action
  • chemical effects: adrenaline and noradrenaline are released from adrenal glands
  • cardiovascular effects: heart rate and strength of the heart beat increase, readying the body for action by speeding up blood flow and improving the delivery of oxygen to the tissues
  • respiratory effects: speed and depth of breathing increase, which brings oxygen to the tissues and removes waste. This creates feelings of breathlessness, choking or smothering, or chest pains
  • sweat gland effects: sweating increases, which cools the body and makes the skin slippery
  • other physical effects: pupils widen to let in more light- creating blurred vision or spots. Salivation decreases- dry mouth, decreased activity in digestive system-nausea and heavy feeling in stomach, muscles tense in readiness of fight or flight- aches, pains, and trembling
  • see table 7.1 p.193


cognitive symptoms of anxiety


  • subjective feelings of apprehension, nervousness, difficulty concentrating and panic
  • search for potential sources of threat
  • difficulty focusing on everyday tasks because of this
  • see table 7.1 p. 193


behavioral symptoms

  • aggression and a desire to escape the threatening situation
  • avoidance behaviors are negatively reinforced because they make the anxiety rapidly decrease
  • see table 7.1 p.193

anxiety vs fear and panic

  • anxiety: future oriented emotion characterized by feelings of apprehension about upcoming events
  • fear: an immediate alarm reaction to current danger or life-threatening emergencies
  • panic: a group of physical symptoms of the fight/ flight response that unexpectedly occur in the absence of any obvious threat or danger- present oriented

normal fears, anxieties, worries and rituals

  • many fears are developmentally appropriate and decline with age
  • anxieties are also common but do not show an age related decline
  • older children report a greater variety and greater complexity of worries- helps prepare for the future
  • children with anxiety disorders worry more intensely than those without a disorder
  • ritualistic and repetitive is very common and helps them gain control and mastery over their environments

separation anxiety disorder

age inappropriate, excessive and disabling anxiety about being away from their parents or away from home (past preschool) 

DSM-IV criteria for separation anxiety disorder

4 of the following for a duration

  • excessive distress when separated from major attachment figures
  • excessive worry about losing or major harm occurring to major attachment figures
  • excessive worry that an untoward event will lead to separation from a major attachment figure
  • reluctance to go to school or elsewhere because of fear of separation
  • excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings
  • reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home
  • repeated nightmares with the theme of separation
  • complaints of physical symptoms when separation from major attachment figures 

characteristics of separation anxiety disorder

  • most common childhood disorder (10%)
  • somewhat more prevalent in girls than boys
  • onset may be chronic or sudden
  • school refusal, refusal to attend class or, difficulty remaining in school for the entire day
  • 2/3 meet criteria for other disorders, 1/2of them will develop depression
  • includes test anxiety

Treatments for separation anxiety disorder

  • exposure
  • behavioral plan
  • for kids that refuse to go to school= MAKE THEM GO!!
  • coping cat

generalized anxiety disorder
excessive and uncontrollable anxiety and worry about the number of events/activities more days than not- can be different worries, but you spend most of your day worrying- has to happen for at lease 6 months
DSM-IV criteria for GAD

  • person finds it difficult to control the worry
  • anxiety is associated with the following:

- restlessness or feeling keyed up on the edge

- difficulty concentrating or mind going blank

- irritability

- muscle tension

- sleep disturbance

characteristics of GAD

  • may serve to reinforce behavioral avoidance
  • occurs in 3-6% of children
  • equal rates in boys and girls
  • onset in late childhood or early adulthood
  • highly comorbid with other anxiety disorders and depression

Treatment for GAD:coping cat


  • cognitive-behavioral treatment


- isolate maladaptive thoughts and reconstruct them

- provide evidence contrary to their thoughts through exposure


  • used for younger children- kindergarten 
  • four components:


- recognize anxious feelings and physical reactions

- clarify feelings they are having in the anxiety provoking situation

- develop a coping plan: what is going to help them in the anxiety provoking situation?

- evaluate performance and teach ways to reinforce the good behavior

Specific Phobia

  • extreme fear of particular objects or situations that pose little or no danger
  • thought that infants were hardwired with them to protect them from the environment
  • most common in children- animals
  • 5 subtypes:
  • 1. animal
  • 2. natural environment
  • 3. blood injection/ injury
  • 4. situational
  • 5. "other"

DSM-IV criteria for Specific Phobia

  • persistent fear that is unreasonable and cued by presence or anticipation of an object or situation
  • exposure to object/situation provokes immediate anxiety response; make take form from may take place from a situationally-bound or situationally-prone panic attack (in children anxiety can be expressed as crying, tantrums, freezing, or clinging)
  • person realizes that the fear is excessive an unreasonable (not necessarily in children)

Five Sub-Types of Specific Phobia


  • Animal: most common is animals- specifically dogs, snakes, insects and mice
  • Natural environment: heights, storms, darkness, water
  • Blood injection/ injury: seeing blood injections, injury or medical procedures
  • situational: flying, elevators, tunnels, bridges, driving
  • other: hiccuping, vomiting, fear of numbers


Characteristics of phobias
  • leads to avoidance or impairments in normal routines
  • do not recognize that fears are extreme or unreasonable
  • evolutionary theory: infants are biologically predisposed to certain fears that alert them to possible sources of danger
  • occurs in 2-4% of all children
  • 4-10% met it at some point in their lives
  • more common in girls than boys
  • most common comorbid disorder is anxiety disorder- which is true of most anxiety disorders 


Treatment for anxiety- modeling
watching someone else engaging in fear
treatment for anxiety- role playing
asking child how they would react in a situation and then finding a better way to deal with that situation and then reinforcing that behavior
treatment for anxiety- in-vivo exposure
exposing themselves to the fear and staying there until the anxiety is down
treatment for anxiety- types of exposure

  • most effective= pairing exposure with reinforced practice and response prevention
  • graded exposure: generate a list of fears (least to most), and gradually expose- pair with a fear thermometer
  • systematic desensitization: teach relaxation, construct fear hierarchy, present anxiety provoking stimuli while child practices relaxation
  • flooding: exposure is prolonged and repeated
  • response prevention: not allowing escape or avoidance

social anxiety disorder

  • marked and persistent fear of being the focus of attention or doing something humiliating
  • anxious about mundane tasks (i.e. public speaking or tripping when entering a room)
  • more likely to be highly emotional, socially fearful or inhibited, sad and lonely
  • generalized social phobia: most severe form: fear of every social situation possible

DSM-IV criteria for Social Phobia
  • Marked fear of one or more social/ performance situations where person if exposed to unfamiliar people or possible scrutiny by others- person fears that s/he will act in a way (or show anxious symptoms) that will be embarrassing or humiliating 
  • exposure to the feared social situation provokes 
    • may take form of a situationally-bound or predisposed panic attack
  • person realizes fear is unreasonable and excessive (nay be absent in children)
  • feared social or performance situation are avoided or endured with extreme anxiety
  • more criteria in book



  • person recognizes fear is excessive and unreasonable


Characteristics of social anxiety disorder
  • age of onset is mid-adolescence- extremely rare in children < 10
  • occurs in 1-3% of children
  • 66% have another anxiety disorder diagnosis- usually specific phobia or panic disorder and a lot self medicate with drugs/alcohol
  • affects slightly more girls than boys- might be more concerned what others think of them more than boys 
  • selective mutism may be symptom???


Obsessive Compulsive Disorder (OCD)

  • recurrent, time-consuming disturbances that cause anxiety
  • often accompanied by anxieties that are performed to relieve anxiety
  • usually immune to reason
  • children try to involve parents in their rituals- rituals don't tend to provide long term relief, so they are repeated often

DSM-IV:OCD- Obsessions

  • recurrent and persistent thoughts, impulses, or images that are intrusive and cause marked anxiety or distress 
  • thoughts, impulses, images are not simply excessive worries about real-life problems 
  • person attempts to ignore such thoughts, impulses, images or to neutralize them with some other thought or action 
  • person recognizes that the obsessional thoughts, impulses, or images are a product of his/her own mind

DSM-IV:OCD- compulsions

  • repetitive behaviors (ex, hand washing, ordering, checking) or mental acts (ex, praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession/ rules that must be applied rigidly 
  • behaviors or mental acts are aimed at preventing/ reducing distress or dreaded event; not connected in a realistic way to what they are designed to prevent

Characteristics of OCD

  • resist and logic and reason- they are aware of the illogical and irrational nature of their beliefs
  • severely disruptive
  • occurs in 2-3% of all children- mean onset of age is 9-12
  • a lot of comorbidity- depression odd and cd
  • chronic in nature- doesn't go away on its own and requires treatment; if not treated in childhood, can persist into adulthood

Treatment for OCD

  • exposure and response prevention- can't do their ritual, use fear hierarchy, slow progression
  • medication- Luvox is the only FDA approved medication; once medication is stopped, obsessions and compulsions will come right back

Panic disorder

  • characterized by recurrent and unexpected panic attacks 
  • persistent concerns about the implications and consequences of having another attack 
  • a sudden and overwhelming period of intense fear or discomfort that is accompanied by physical and cognitive symptoms

symptoms of a panic attack

4 or more of the symptoms that come on abruptly and reach their peak within 10 mins 

  • pounding heart/accelerated heart rate
  • sweating
  • trembling, shaking
  • sensations of shortness of breath
  • chest pain/discomfort
  • nausea, abdominal distress
  • dizzy
  • feelings of unreality/detachment
  • losing control or going crazy
  • dying- fear of
  • numbness
  • chills or hot flashes

Characteristics of panic disorder

  • can lead to agoraphobia
  • age onset is 15-19 years
  • Panic attacks common (3-4% teens)
  • Panic disorder less common (~1% of teens)
  • lowest rate of remission
  • more common in females than males
  • usually caused by a stressful life event
  • comorbid with other anxiety disorders and depression 
      • at more risk for suicidal behavior and alcohol/drug abuse
      • worst prognosis of all anxiety disorders

Post Traumatic Stress Disorder

  • characterized by persistent anxiety following an overwhelming traumatic event that is outside the range of usual human experience
  • core features 
      • re-experiencing of the traumatic event
      • avoidance of associated stimuli and a numbing of general responsiveness
      • symptoms of extreme arousal

Acute stress disorder

  • characterized by the development of dissociative symptoms
  • must occur within one month after exposure to an extreme traumatic stressor
  • lasts at least 2 days but not longer than 1 month

Characteristics of Anxiety disorders- cognitive disturbances 

  • excessive anxiety may be related to deficits in memory, attention, speech, and language
  • can interfere with academic performance
  • Threat-Related Attentional Biases 
      • engage in negative self-talk

Characteristics of Anxiety disorders- social and emotional deficits 

  • social withdrawal
  • loneliness
  • low self-esteem
  • difficulty making friends and maintaining friends
  • deficits in understanding emotions and understanding the difference between thoughts and emotions



  • high comorbitity between anxiety and depression
    • social phobia
    • GAD 
    • separation anxiety disorder
    • less likely in specific phobia
  • anxiety usually precedes depression
  • share underlying of negative affectivity


Depression- Early theories

  • Psychoanalytic
    • view anxieties and phobias as defenses against unconscious conflicts that are rooted in child’s early upbringing
  • behavioral/learning
    • fears and anxieties are learned through classical conditioning and maintained through operant conditioning 
  • attachment
    • early insecure attachments lead children to view the environment as undependable, unavailable, hostile, and threatening

Depression Causes: Temperament

  • low threshold for novel and unexpected stimuli
    • behavioral inhibition
  • affected by parental response to anxiety
    • parents who set firm limits and teach their children to cope with stress have better outcomes

Depression Causes: Genetic and family risk

  • studies show there is a biological vulnerability to anxiety disorders
  • twins studies show that they can have different anxieties, so what is inherited is the disposition to become anxious
  • for of the disorder is a function of the environment
  • highest genetic influence is ODC and the trait of shyness/inhibition

Depression Causes: Neurobiological Factors

  • Overall Behavioral Inhibition System (BIS)- overactive in anxious individuals
    • HPA system, limbic system, prefrontal cortex, brain stem
    • amygdala
  • Neurotransmitters
    • Norepinephrine
    • GABA
    • Neuropeptides
    • Serotonin

Depression causes: family factors


  • excessive parental control
  • prolonged exposure to family dysfunction
  • low parental expectations for children’s coping
  • Low SES
  • insecure early attachments


Caveat about mood disorders

  • None of the mood disorders were written with children in mind. All of the criteria were written for adults
  • This is a particularly relevant for Bipolar Disorder
  • Depressive disorder- dysphoria, anhedonia
  • Bipolar disorder- extreme depression to extreme elation or mania

Main Features of Depressive Mood Disorders

  • feelings of sadness that are more exaggerated and persistent
  • irritability, guilt, shame
  • symptoms have been known as the “common cold” of psychopathology
  • most common
  • a lot of the time goes unrecognized and unfortunately untreated
    • children were previously thought to not be able to get it
    • thought that children didn’t have the cognitive capacity to be depressed
    • now know that they have it but they don’t have the ability to express it
    • often overlooked because it co-occurs with other disorders

Main features of Depressive disorders: behavior

  • restlessness, agitation
  • decreases in activity and socialization
  • excessive crying
  • verbal sarcasm
  • destruction
  • drug and alcohol abuse to self medicate (adolescence)

Main features of Depressive Disorder: Thinking (cognitive)

  • preoccupied with thoughts
  • self-critical and self conscious
  • difficulties
    • concentrating
    • focusing
    • remembering things
    • making decisions

Main features of depressive disorder: physical

  • eating
    • appetite loss
    • eating too much
  • sleeping
    • early morning wakening
    • feeling tired all of the time
  • headaches, stomachaches, nausea, aches and pains

How common is depression in children?

  • one of the most disabling childhood disorders
  • previously not believed to occur
  • 5%- children
  • 10-20% adolescence
  • rare in kids <6
  • once an episode occurs, relapse rates are high
    • 25% chance of relapse in one year
    • 50% chance of relapse in two years
    • up to 70% chance of relapse in next five years
  • sex differences
    • childhood: M=F or M>F
    • adolescence: F>M
    • *****know for exam!!!!!!*******

DSM-IV Mood Disorders

  • major depressive disorder
  • dysthymic disorder
  • bipolar disorder (I and II)
  • cyclothymic disorder
  • depression disorder not otherwise specified

DSM-IV criteria for a major depressive episode

  • need 5 of 9 and have to have 1 of the first 2 criteria
  • depressed mood most of the day, nearly every day, for at least 2 weeks
    • in children and adolescence, can be irritable mood
  • loss of interest in pleasurable activities most of the day, nearly every day, for a least two weeks
  • significant weight loss or weight gain, or decrease or increase in appetite nearly every day
  • insomnia or hypersomnia nearly every day
  • psychomotor agitation or retardation nearly every day
  • fatigue or loss of energy nearly every day
  • feelings of worthlessness or inappropriate guilt. nearly every day
  • diminished ability to think or concentrate, or indecisiveness, nearly every day
  • recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation, or a suicide attempt or specific plan for committing suicide

MDD: Comorbidity

  • 70% of children and adolescence with MDD have another disorder
  • disorders usually precede depression and persist after depression remits
  • anxiety, dysthymia, conduct problems, ADHD, and substance abuse

Tripartite Model

Physiological hyperarousal -> Anxiety <- negative affect -> Depression <- (low) positive affect

MDD: Onset, Course, and Outcome

  • age of onset of first episode usually around 14
  • average episode lasts 8 months
  • after recovery, reoccurrence is common along with sub threshold symptoms, health problems, chronic stress and adjustment

DSM-IV: Dysthymic Disorder

  • depressed mood for most of the day, for more days than not, for at lease 2 years
    • one year for a child
  • must be accompanied by 2 or more
    • poor appetite or overeating
    • insomnia or hypersomnia
    • low energy or fatigue
    • low self-esteem
    • poor concentration or difficulty making decisions
  • double depression- DD with a major depressive episode

DD: Prevalence and Comorbidity

  • rates of DD are lower than MDD
  • most common comorbid disorder is MDD
  • peaks around 11-12 years
    • may be a precursor for MDD
  • average episode length= 2-5 years
  • most recover but are at high risk for developing other disorders
    • have less social support than other adolescence

CBT for MDD and DD

  • provides the most long- and shirt-term success in children and adults
  • also want to change negative attributions
    • internal- blame themselves
    • stable- think that it will never change
    • global- applies to all they do and in most situations
  • focus on changing the negative cognitive triad
    • self- there is nothing good about me
    • world- it’s not worth it
    • future- i’ll never be able to graduate

Types of CBT approaches

  • Primary and Secondary Control Enhancement Training (PASCET)
    • ACT skills- changing objective events (behavioral)
    • THINK skills- altering subjective impact of stress (cognitive)
  • Taking Action
    • A= Always find something to do to feel better
    • C= Catch the positive
    • T= Think about it as a problem to be solved
    • I= Inspect the situation
    • O= Open yourself to the positive
    • N= Never get stuck in the negative muck

Medication controversy: MDD and DD

  • The only SSRI that is FDA approved for treating depression in kids is Prozac
    • Zoloft and Paxil are prescribed “off label” 
      • treating them but there is no research evidence supporting the effects, but there is plenty of evidence for adults
    • lacking info about the development in children

FDA Review

  • No completed suicides occurred among nearly 2,200 children treated with SSRI medications
  • About 4 percent of those taking SSRI medications experienced suicidal thinking or behavior, including actual suicide attempts
    • The RIsk: Too depressed to actually go out and perform the act of suicide, so when you begin to take the medication, it makes you feel good enough to go out and do so

Time Magazine Nov. 7, 2007

  • Centers for Disease Control and Prevention reported:
    • suicide rates in young people ages 10-24 were up 8% from 2003 to 2004
    • another study found that during this period, new prescriptions for antidepressants fell, perhaps because of the fears about them
    • don’t know if it is causal, there is just a correlation
  • Black Box warning issued- most serious type of warning that the FDA can issue


  • 30% of children/adolescence who are clinically depressed attempt suicide by 17 years of age
    • 3rd leading cause of death in 10-14 year olds
  • Among children/adolescence who kill themselves, odds of having major depression are 27x more than controls
  • Ages 13-14:peak for first suicide
    • Doubled risk for another suicide attempt after the first attempt
  • Attempts double in adolescence, but decline after 17-18
  • Suicide warning signs- see book

The difficulty of Bipolar in children

  • Low base rate of occurrence- so people don’t even consider it
  • Extreme variability in clinical presentation within and across episodes
  • Overlap in symptoms with other disorders, especially ADHD
    • Pressured speech: too many thoughts going on that they are forcing all of them out of their mouthes
    • Grandiose beliefs: thought that they could fly, that they are the smartest kid in the world, etc. 
    • Manic symptoms are hard to distinguish from hyperactive and impulsive symptoms of ADHD

Bipolar disorder: Symptoms

  • Periods of abnormally and persistently elevated, expansive, or irritable mood, alternating with or accompanied by 1 or more depressive episodes
    • mood states= elation and euphoria
  • Irritability and rage
  • Silly, giddy, over-excited, over-talkative
    • grandiose beliefs

DSM-IV symptoms of a manic episode

  • 3 or more euphoric, 4 or more irritability- persist for 1 week
    • If needs hospitalization, no time requirements
  • Inflated self-esteem or grandiosity
  • decreased need for sleep (e.g., feels rested after 3 hours)
  • more talkative than usual, or pressure to keep talking
  • flight ideas or racing thoughts
  • distractibility
  • increase in goal-directed activity
  • excessive involvement in pleasurable activities that have painful consequences

Bipolar I disorder

  • One or more manic or mixed episodes and one or more major depressive episodes
  • Mixed episode= criteria met for manic and major depressive episode
  • Hard for children to have
  • More severe and lasts longer

Bipolar II Disorder

  • One or more major depressive episodes accompanied by at least one hypomanic episode
  • Hypomanic episode= similar to manic episode except that it is less severe, shorter in duration, and less degree of impairment
    • No deterioration in functioning, need for hospitalization, or psychotic symptoms
  • More common in children
    • could start out with II and then move on to I
    • have rapid cycling which is not in DSM

Cyclothymic Disorder

  • Numerous hypomanic and depressive symptoms that do not meet full criteria for either a manic episode, mixed episode or major depressive disorder
  • In children, must occur for at least 1 year
  • No more than 2 consecutive symptom-free months
  • Significant distress or impairment in functioning

Bipolar disorder: Prevalence

  • Affects .4%- 1.2% of children
  • Extremely rare prior to puberty
  • Rapid cycling
  • More likely to be diagnosed with Bipolar II or cyclothymia
  • Affects males and females equally
    • males more likely to have manic, females more likely to have depressive

Bipolar Disorder: Comorbidity

  • Anxiety Disorder
  • ADHD Conduct Disorders
  • Substance Abuse
  • Cardiovascular, metabolic disorders, epilepsy and migraine headaches
    • neurological 

Bipolar Disorder: Onset, Course and Outcome

  • Peak age of onset is between ages of 15-19 years
    • extremely rare prior to 10
  • depressive episode usually occurs first
  • chronic in nature and resistant to treatment
    • the earlier the onset, the more chronic and resistant it becomes
  • poor long-term prognosis 
  • read in book

Bipolar Disorder: Treatment

  • Like Diabetes- once its there it doesn’t go away, but you can manage it and learn to live with it
  • Multi-modal
    • Education
    • Medication
      • lithium
    • Therapy
      • social rhythms

Associative characteristics of depressive disorders

  • Interference with academic performance
  • Cognitive disturbances
    • attributions of failure, ruminative style, negative automatic thoughts, hopelessness
    • negative feelings generalize across situations
  • Low or unstable self-esteem
    • might be due to a poor body image
  • Social problems
    • few friends, feelings of loneliness and isolation, ineffective coping styles, social withdrawal
    • families characterized as less supportive, conflict ridden, socially isolated from family
  • Poor interpersonal relationships
    • conflict with parents and siblings
  • Suicidal thoughts
    • 16-30% attempt
    • strongest risk factors: being a female and having a mood disorder

Psychodynamic theory

  • depression results from the actual or symbolic loss of a love object
  • viewed depression as the conversion of aggression into inward ange

Attachment theory

  • focuses on parental separation and disruption of a secure attachment bond as predisposing factors of depression

Behavioral theories

  • Emphasis on the importance of learning, environmental consequences (lack of response contingent positive reinforcement)
  • Skill deficits

Cognitive theories

  • Focus on the negative perceptual and attributional styles and beliefs
    • negative information processing: only look for the negative aspects of the world
    • negative automatic thoughts
    • internal, stable, and global attributions for the causes of negative events
    • negative cognitive triad- negative outlook about oneself, the world, and the future
    • negative cognitive schemata

Mood disorder Causes: genetic and family risk

  • Moderate genetic influence
    • heritability estimates range from .35-.75 across twin studies
  • family and twin studies
  • what is actually inherited is the vulnerability to depression and then the environmental stressors will bring them out

Mood disorder causes: Neurobiological influences

  • Children with depression may have heightened reaction to stress (frontal lobe)
  • HPA axis, amygdala, hippocampus, sleep architecture (abnormal EEGs), growth hormone and neurotransmitters may be involved 
    • seratonin, dopamine and norepinephrine

Mood Disorder Causes: Family influences

  • Children are at risk if they have....
    • families with more anger, conflict, disorganization, and over- involvement/ control. poorer communication, high stress levels, and less warmth and support
    • parental depression (more likely for children before puberty)

Mood Disorder Causes: Stressful life events

  • Increases in stress associated with increases in depression
    • moving
    • birth of a sibling
    • death of a loved one
    • changing schools
    • parent conflict or divorce
    • family violence
    • lack of family resources
    • serious accident or family illness
  • see triggers in book

Mood Disorder Causes: emotion regulation

  • Children who have...
    • problems regulating negative emotional stress
    • difficulty overcoming negative moods who then use avoidance and negative behavior to regulate distress
  • are more prone to depression

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