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318 Cards in this Set

  • Front
  • Back
• A developmental brain disorder
• Affects social functioning
Autism:___increase in pediatric prevalence
between 1991-1997*
• A lot of research funded
to help understand it.
• 5-fold increase since 1997!
Autism =
“within oneself”
– Children “withdrew into shells”,
“disregarded people for objects”,
“avoided eye contact”
– “perservation of sameness”
– didn’t speak much
Leo Kanner
-similar observations to kanner
-similary socially to autism
-but spoke
Hans Asperger
disruptions in development
• Autism
• Asperger syndrome
• Rett syndrome
• Childhood Disintegrative Disorder
pervasive developmental disorder (PDD)/autism spectrum disorder (ASD)
more common in boys
no language impairment, highly functional
Asperger syndrome
more common in girls
Rett syndrome
develop fine, then regress
Childhood Disintegrative Disorder
don't meet all the criteria
Time Trends: Autism
Significant increase in prevalence
Now: ~____ per 10,000 (US)
1960s: ~___ cases per 10,000
Why the increase?
– Improved diagnostic ascertainment
– Broadening of diagnostic concept
– Environmental factors cannot be excluded
Autism: A developmental disorder
• Diagnosed between age ___
• Usually because
kids fail to show age-typical
behavior (fail to speak!)
• First signs at around ___ months; obvious by
Boys:girls ___
Most patients require...
• Some people with autism can
..lifelong assistance.
..have productive and somewhat independent lives.
most common comorbiditity
• Mental Retardation (70%)
• Epilepsy (25%)
– onset adolescence/adulthood
• DSM -IV-TR: must have at least some impairment in each of areas
a), b) & c).
a) Social interaction
b) Language, communication & imaginative play
c) Range of interests and activities
• Associated characteristics:
– IQ
– Sensory impairments
– Cognitive deficits
Symptoms: social interaction
• Difficulties engaging in social interactive behaviors
eye-contact, gestures (pointing), joint attention, peek-a-boo,
little/no social referencing
• little interest in people
• difficulties establishing social relationships
• difficulties sharing (emotional)
Some good news…
• Even though children with autism may
not like typical affection from their
parents, they do form attachments with
their caregivers.
Symptoms: Language,
Communication & Pretend play
• Delay or absence of precursors to
language/communication (babbling, communicative
• Delay or absence of language production &
• Only ~ 50% ever learn “normal” language, but often
stereotypical and devoid of meaning
• Gestures: instrumental but not expressive
• Impairments in speech pragmatics
• Echolalia (parroting)
• Absence of pretend play
• Only ~__ ever learn “normal” language, but often
stereotypical and devoid of meaning
Gestures: _____but not ______
Symptoms: Range of interest
• Preoccupation with one/few types of activities
• Stereotyped & restricted interest
• Stereotyped & restricted motor mannerisms
(hand-flapping,rocking, self-stimulation)
• Inflexible adherence to non-functional
Associated characteristics: IQ
• Can span the entire range but
• ____% mental retardation
(IQ < 70)
__average or above average IQ
30 %
• ___have splinter skills
___autistic savants
– The real “rainman”
• Read by 16 months
• By age 4 memorized 8 encyclopedias!!!
Associated characteristics:
Sensory processing
• Hyper/Hyposensitivity:
Stimulus overselectivity:
they really like one type of stimulus
Stimulus overselectivity:
• Hyper/hypovision (in infancy)*
• Hyper/hypohearing
• Hyper/hyposmell/taste
• Hyper/hypotactility
– Might explain why some
• avoid people
• Don’t like to be touched or cuddled
• Are really picky eaters
Associated symptoms:
Emotional processing
– Problems expressing emotions (facial and vocal)
– Problems processing others’ emotional
expressions (facial and vocal)
– Problems relating to others’ emotions (empathy)
Associated symptoms:Processing of faces
•More scanning
of inside features
•More focus
on outside features
•More focus on mouth
Cognitive deficits: Impairment in ToM
• Theory of mind
• People with autism often have trouble in
situations that require “reading others’ minds”
Imagine you see a guy walk into this lecture hall.
He looks around the class, looks at the screen and at me,
then turns around and leaves the room.
What kind of inference do you make?
Impairment in ToM: The Sally-Anne Task
is a...
• A false-belief task
Impairment in ToM: The Sally-Anne Task
• A false-belief task
-Young kids have trouble with this too
-Typical kids can solve this
by the age of ___.
- Older kids and adults with
autism still have trouble with this
Cognitive Deficits: Executive Functioning
– Problems with
• Higher order planning and regulation of
– Problems with
• planning actions
• Ignoring distractions
• Inhibiting inappropriate behaviors
• Flexibly shifting from one task to another
Memory and autism
Very specific memory problems:
– Few/no organizational strategies
– Visual spatial working memory
– Face memory (local not global)
– Memory for social scenes
– Complexity (sentences)
Main idea: things are less coherent and harder to remember
Visual spatial working memory
people with autism do worse on this
Memory and autism
Central Coherence:
processing in bits and
Causes of autism
• Early notion: “refrigerator mom’s”
• Origin is neurobiological
• Genetic and non-genetic
– Twin studies: not always do both have
diagnosis and if, then phenotype can be very
Genes & Autism
• single gene?
• As many as ___ genes involved
• Heritability __%
• ___ risk among siblings
• Monozygotic twins: ____
• Dizygotic twins: ~___
• Most strongly genetic psychiatric disorder of
• Not just a single gene
Environmental influences
• Pre/perinatal complications
– Infections, teratogens (Alcohol,
Thalidomide), prematurity,problems during
• Diets (Gluten & Casein)
• Vaccines: containing thimoresol (mercury)
Where in the brain…
• No single region has yet been identified
• Candidates: cerebellum, frontal cortex,
hippocampus, amygdala
A brain that grows too fast
• Heads small in the
• Rate of growth very fast -
larger than normal head
•The faster the rate,the more
severe the outcome
Structural differences
• Small cerebellum
• Parietal, Temporal & occipital lobes are
all larger.
• Hippocampus:
– Smaller cells, more
densely packed
Face processing
• Not much attention to faces
• Faces considered threat ? *
• Activity in amygdala ↑
• ↓ when gaze is averted
Chemical imbalances
• Serotonin
• Dopamine
• Oxytocin
– Bonding hormone
• Early diagnosis & intervention is KEY.
experience can change the way the brain “wires
• Different treatment for different patients.
Treatment Types:
– Occupational/physical therapy
– Behavior modification
– Sensory integration therapy
– Diet & medications
Treatment Types
Behavior Modification
1.Sensory Integration
Therapy (SIT)
2.Listening to sounds,
touching things
3. Play Therapy & Social
4.Behavior & Communication
•Speech Therapy
•Picture Exchange
Communication Systems
Sensory Integration
Therapy (SIT)
involves: Listening to sounds,
touching things
goal: Help individuals deal with
sensory stimulation
Play Therapy & Social
Involves : Child controlled adult-child interaction
Goal: Improve emotional
development, social skills
and learning
Behavior & Communication
•Speech Therapy
•Picture Exchange
Communication Systems
Involves: •Learning appropriate
•Learning how to use
language and symbols to
express needs
Goal:• Helps improve behavior
• Help individuals with
ability to use speech &
gestures to communicate
Sensory Integration Therapy
Goal: to “understand” sensory stimulation
• Just Right Challenge
• Adaptive Response
• Active Engagement
• Child Directed
Social stories™
• Write a story/draw a comic strip
- Geared towards an individuals problems
- Help understand “confusing” social
• Brushing my teeth
• How to have a friend over (turn-taking, sharing)
• Happiness is a good feeling
• How to make someone happy.
• Why do adults forget….
Discreet trials training (DTT)
• Like “shaping” in OC.
• Reinforcing steps towards right
• Using rewards specific to the child
-get pic cards
-use cards to express needs, desires, feelings
Childhood Onset Schizophrenia (COS)
a severe form of schizophrenia with
onset as early as elementary school
(less than 14 years of age)
Schizophrenia (SZ) is a disorder of the brain
that is expressed in abnormal mental function
and disturbed behavior.
Schizophrenia (SZ)
______ is a disorder of the brain
that is expressed in abnormal mental function
and disturbed behavior.
…”thinking problems”
…”magical” thinking
not usually raving maniacs on the rampage more often __________.
in general, lower than _________.
modal onset = _______
not “split” personality
not necessarily _________
shy, withdrawn and preoccupied
normal intelligence (IQ 100)
25 years old [COS < 12 years]
chronic or a lifetime affliction
Categories of SZ
Undifferentiated and Residual
delusions of persecution or grandeur
intensely emotional or very formal
Paranoid type
silliness and incoherence
insensitivity to external cues
hypersensitivity to internal cues
enormously excited or strikingly frozen
negativism (oppositional behavior)
milder form
Undifferentiated and Residual-
Symptoms in SZ
Disorganized speech- scattered topics, tangential
Memory impairment- poor short-term,
usually normal long-term
Attentional filter- poor separation of relevant from
irrelevant information, thus
nonsensical over-inclusiveness
Perceptual deficits- distorted spatial or auditory percepts
(not! a sensory problem)
Motor deficits- below normal coordination & small motor
scattered topics, tangential
Disorganized speech-
poor short-term,
usually normal long-term
Memory impairment-
poor separation of relevant from
irrelevant information, thus
nonsensical over-inclusiveness
Attentional filter-
distorted spatial or auditory percepts
(not! a sensory problem)
Perceptual deficits-
below normal coordination & small motor
Motor deficits-
major impairment in the understanding of reality
bizarre delusions (false beliefs)
hallucinations (false perceptions)
affect ranges from wild agitation ⇒ expressionless
psychotic behavior
cardinal sign of psychosis
bizarre and magical thinking
Difficulty of diagnosing children
The problem for diagnosis of COS
is that it is really not possible to distinguish between
the rich, unrestrained imagination of normal children
and the hallucinations brought on by psychosis.
Particularly when very young, psychotic children
do not find hallucinations disquieting (as do adults).
cardinal sign for COS:
gradual, not sudden, onset of
bizarre thinking that has a profound negative impact
on the child’s social and academic development
Particular symptoms for COS
dysfunction in frontotemporal regions is inversely
correlated with age of onset
neurological soft signsindications
of minor neurological abnormalities
more prevalent in children who are later
diagnosed with COS
withdrawal from social contact
SZ: ~ 1.1 in 100 adults
or 1.1%
~ 1.0 in 10,000 children
or ~0.005 % very very rare... probably only 3 in san diego
COS onset is
2 to 4 years younger and twice
as prevalent in boys
SZ is equally prevalent in males and females
!yet !
boys develop more slowly than girls
So, is estrogen a protective factor that delays the
course of SZ?
Comorbidity in COS
conduct problems
suicidal tendencies
70% of COS patients have comorbidity
most commonly oppositional behavior or mood disorder
[prevalence of autism in COS cohort is the same
as in the general population]
Causes of SZ
Genetic correlations
Heritability is a significant risk factor
MZ twins: 1:2 pairs where one twin is diagnosed
with SZ, the other twin develops SZ
in pairs where the first diagnosis finds
severe SZ, the other twin develops SZ
77% of the time
Developmental disturbances
Issues- COS less prevalent in girls
COS predicts the severity of SZ
COS onset predicts severity
motor symptoms and short-term
memory impairment indicate disturbance
of normal developmental in frontal lobes
discomfort with social relationships
along with cognitive or perceptual distortions
may be a precursor of COS
schizotypal personality disorder
Dopamine pathways in SZ
neuroleptic medications treat positive symptomschlorpromazine,
regulate hyperactivity in frontal lobes
control psychotic symptoms
reduce dopamine turnover
(m.a.= binding to D2 receptors)
causes Parkinsonian symptoms
(~7 years, 24% of SZ Rx neuroleptics
develop tardive dyskinesia)
an external factor that challenges the body’s
normal efforts to maintain homeostasis
(stress is a normal and necessary part of how
the body regulates vital processes)
is how the body meets the stressor
demand on the CNS to
activate the HPA axis (adrenal glands) &
retard the immune system
allostatic load-
-when allostasis is not functioning properly
major causes: chronic anxiety
sleep deprivation
HPA axis increases cortisol level
-chronic increase in cortisol depresses
the immune system and is toxic for
cortical neurons (i.e., cortisol ⇑ PTSD)
Allostatic load
Treatment for COS
psychosocial intervention
______ control psychotic symptoms,
but have unacceptable side effects over time
_________treat positive symptoms
without apparent negative symptoms
risperidone, olanzapine, clozapine (+risk)
atypical antipsychotics
_______involves adjustment of
school environment and academic load, training
to manage interpersonal communication,
and psychotherapy for COS and family
psychosocial intervention
Outcome SZ
Treatment for COS includes biological, educational, and social
interventions. Medication is the cornerstone of treatment, but
should be viewed as a means to facilitate psychological
and social interventions. Treatment with only medication is not
as effective as medication combined with other forms of treatment.
The outcome for children with COS varies greatly…some
individuals function well with medication. When symptoms are
recognized early and treated so that school and family life can
continue, some COS patients learn to cope. This positive outcome
can forestall or reduce the longterm cognitive impairments
associated with SZ.
transduction of energy
how brain organizes sensation
In the Shining
- symptoms
catatonic, locked up
+ symptoms
halucinations, delusions
Problems that occur in the absence of other
obvious conditions
Communication & Learning Disorders
areas of communic. and LD
• Listening
• Speaking
• Reading
• Writing
• Reasoning
• Mathematics
***_____ have LD and MR***
CANNOT bc. normal IQ for LD
– Producing speech sounds
– Speech fluency
– Using spoken language to communicate
– Understanding what other people say
• Communication Disorders
– Reading
– Math
– Writing ability
• Learning Disorders
– Producing speech sounds
– Speech fluency
– Using spoken language to communicate
expressive language disorder
– Understanding what other people say
mised expressive perceptive
– Reading
prob solve and see abstract relationships
logical mathematical intelliegence
perception and manipulation orientation of objects
spacial intelligence
hearing and manipulating tones and rythums musical patterns and pitch
musical intelligence
use the body to coordinate movements
bodiliy kinesthetic intelligence
how attuned to nature
naturalistic intelligence
sense moods and felings and actions of others
recognise define and pursue inner feelings and thoughts
meaning function and gramatical rules of words
1. Approach learning in different ways
2. Tailor educational methods
3. Strengthen existing abilities
Important Concepts
basic sounds building blocks of words (ba, da)
how many phenomes are there
___ is one of the best predictors of school performance in overall intelligence
lanugage development
– Recognizing the relationship that exists between
sounds & letters, detection of rhyme & alliteration,
and awareness that sounds can be manipulated
within syllables in words
Phonological Awareness
most intensive period for language development
1st 3 yrs of life
by ___ kids recoginize basic so8unds of their native language
6 months
by six months they
by 9 months
10 words
Reacts to loud sounds
Turns head toward a sound source
Watches your face when you speak
Vocalizes pleasure and displeasure sounds
Makes noise when talked to
birth-5 months
Understands "no-no"
Tries to communicate by actions or gestures
Tries to repeat your sounds
6-11 months
Attends to a book or toy for about two minutes
Follows simple directions accompanied by gestures
Answers simple questions nonverbally
Points to objects, pictures, and family members
Says two to three words to label a person or objects
Tries to imitate simple words
12-17 months
Enjoys being read to
Follows simple commands without gestures
Points to simple body parts such as "nose"
Understands simple verbs such as "eat," "sleep"
Correctly pronounces most vowels and n, m, p, h
Says 8 to 10 words
Asks for common foods by name
18-23 months
Knows about 50 words at 24 months; says around 40 words at 24
Knows some spatial concepts such as "in," "on"
Knows pronouns such as "you," "me," "her"
Knows descriptive words such as "big," "happy"
Begins to use more pronouns such as "you," "I"
Speaks in two to three word phrases
Uses question inflection to ask for something (e.g., "My ball?")
2-3 yrs
Groups objects such as foods, clothes, etc.
Identifies colors
May distort some of the more difficult sounds: l, r, s, sh,ch, y, v, z, th
Strangers are able to understand much of what is said
Able to describe the use of objects such as "fork," "car," etc.
Has fun with language
Answers simple questions: "What do you do when you are hungry?"
Repeats sentences
3-4 yrs
Understands spatial concepts such as "behind," "next to."
Understands complex questions
Speech is understandable but makes mistakes
Says about 200 - 300 different words
Uses some irregular past tense verbs such as "ran," "fell."
Describes how to do things such as painting a picture
Lists items that belong in a category
Answers "why" questions
4-5 yrs
Understands more than 2,000 words
Understands time sequences (what happened first, second, third, etc.)
Carries out a series of three directions
Understands rhyming
Engages in conversation
Sentences can be 8 or more words in length
Uses compound and complex sentences
Describes objects
Uses imagination to create stories
5 yrs
Communication Disorders
• Expressive language disorder
• Mixed receptive-expressive disorder
• Phonological disorder
• Stuttering
Mixed receptive-expressive language disorder
speaking prob's coupled by difficulty in understanding some aspects of speech
Phonological Disorder
involves articulation or sound production rather than word kowledge
-1, s, r, z, th, ch
Commun. disorders boys __ girls
Commun. disorders what happens with time
language probs usually disappear or diminish with time
Communication Disorders: Causes
• Genetics
• Brain
• Ear infections
• Home environment
_______ show a + family history
In communications disorders they have a prob with the ___part of the brain
part of the brain important for language
___ is important for speech comprehension
-prob for receptive
wernicke's area located in
left temp lobe
broca's area located in
left inf frontal
programs for vocalization (speech outlet)
Broca's area
A problem with Broca's area would be
expressive problem
connects wernicke's and broca's area
arcurate faciculus
repeated and prolonged pronuciation of certain syllables
auditory cortex sends info to
arcurate faciculus-> wernickes->comprehend-> AF->Broca's->
stuttering is
strongly inherited (70%)
normal speech
• Air from lungs pass
through vocal cords
• Vocal cords vibrate &
produce your voice
• Palate, tongue, jaw & lip
modify sound
• Feedback to brain adjusts
diff in perslvian region (houses wernicke's area)
-speak slowl to the child
word recognition or comprehension
reading achievement
handwriting spelling
writing skill
what does it take to read
-focus attention on printed marks
-control e movements
-recognize sounds associated with letters
-understand words and grammer
-build ideas and images
-compare new ideas with what u already know
word level reconition disability
word level reconition disability
-word level reading disability= dyslexia
dyslexia aka
-word blindness
-visual agnosia for owrds
-specific reading disability
__is a specific learning disability that is neurological in
origin. It is characterized by difficulties with accurate and/or
fluent word recognition and by poor spelling and decoding
abilities.These difficulties typically result from a deficit in the
phonological component of language that is often
unexpected in relation to other cognitive abilities and the
provision of effective classroom instruction. Secondary
consequences may include problems in reading
comprehension and reduced reading experience that can
impede the growth of vocabulary and background
core deficit in reading disorders
fluent word reconition
breaking wrod into parts
decoding abilities
3 phonological components
1. fluent word recognition
2. poor spelling
3. decoding abilities
Typical Errors: dyslexia
• Reversals
• Transpositions
• Inversions
• Omissions
• Reversals
b/d, p/q
• Transpositions
seqential errors (was/saw)
m/w , u/n
place instead of palace
constant updating task
control group does better than dyslexia , prob w working memory
most common learning disorder
corse of dyslexia
not good...why ... diagnostic cirteria discrepanc btw IQ and reading achievement
-efficiacious interventions not used
-motivation diminishes
LD: Reading Disorder: Reading Comprehension
Proficient reading comprehension
fluent decoding
-can occur in absence of word recognition prob's
LD: Reading Disorder: Reading Comprehension
Assessment Issues
-response format
-memory demands
-specific aspects of comp
-not alot known
mathetmatics disorder have probs with
-recognize #'s and symbols
-memorize facts
-aligning #'s
-abstract concepts
Verbal dyscalculia
naming amts or numbers
• Practognostic dyscalculia
enumerating, comparing, and manipulating objects
• Lexical dyscalculia
reading and math symbols
• Graphical dyscalculia
writing mathematical symbols
• Ideognostical dyscalculia
understanding concpets and perfoming mentally
• Operational dyscalculia
Learning Disorders: Writing Disorder
Problems with visual-motor abilities
– Writing
– Figure copying
– Figure rotation
finger agnosia
can't tell what finger you're touching
other factors
-low self esteem
-social isolation
5 Stages of Sleep:
Stage 1
Stage 2
Stage 3
Stage 4
high frequent brain waves paralysis of large muscles usuall dream in REM brain activity is like you are awak, large muscles are paralized when you are in REM (not want to re-enact dreams might be wh this happens)
stage ____ area also as important as REM
3 and 4
As an ___ we spend more time in REM than we do when we are older
executive functioning, spending more time in the later part of the night in REM
frontal cortex
Health Related Disorders: Sleep Disorders
•Breathing-related Sleep Disorder
•Circadian rhythm Sleep Disorder
Health Related Disorders: Sleep Disorders
•Nightmare Disorder
•Sleep Terror Disorder
•Sleepwalking Disorder
like insomnia
tired alot
all of sudden fall asleep collapse and fall directly into REM
Sleep Disorders: Dyssomnias
-difficulty initating or maintaining sleep or sleep that is not restorative
-infants repetitive night waking and inability to fall asleep
Sleep Disorders: Dyssomnias
25-50% of 1-3 year olds ...prett common in infants
Sleep Disorders: Dyssomnias
behavioral treatment
family guidance
Sleep Disorders: Dyssomnias
excessive sleepiness
Prevalence & Age:
Common among young children
•Behavioral treatment
•Family guidance
attacks of sleep
-cataplexy-loss of muscle tone...not forever though
•Prevalence & Age:
Sleep Disorders: Dyssomnias
•Circadian Rhythm Sleep Disorder
sleep districution leading (circadian means about a day) to excessive sleepiness or insomnia; light is a big one- depresses melatonin which will make you not fall asleep
•Prevalence & Age:
•Behavioral treatment
Sleep Disorders: Parasomnias
•Nightmare Disorder
happens during REM, repeating aweakenings with recall of dreams VERY FRIGHTENING
Sleep Disorders: Parasomnias
•Nightmare Disorder
•Prevalence & Age:
•Common between ages 3 & 8
•Provide comfort
•Reduce stress
•Sleep Terror Disorder
abrupt awakening from sleep
-1st 3rd of sleep wake up screaming bloody murder and still asleep sort of begins with a panicking scream a racing heart, sweating vocalized ditress glassy eyed stare difficult to arouse inconsolable dioriented no memory of episode in the morning
•Sleep Terror Disorder
•Prevalence & Age:
•3% ages 18 months to 6 years
•Reduce stress & fatigue
•Add late afternoon nap
helps relieve stress
Sleep Disorders: Parasomnias
•Sleepwalking Disorder
•Prevalence & Age:
•15% 1 attack
•1-6% 1-4 attacks per week
•Take safety precautions
•Reduce stress & fatigue
•Add late afternoon nap
Can look like other things
learning difficulties
cognitive deficits
substance abuse
Elimination Disorders: Enuresis
-involuntary discharge or urine
-over 5 y/o
• 3 Subtypes:
1. Noctural only
2. Diurnal only
3. Noctural + diurnal
• Prevalence:
• 13-33% of 5 y.o. wet their beds
• More common
enuresis more common
in boys than girls
-less educated
-lower SES groups (less structure with this class and need that for potty training and ther is also added stressor as well)
declines rapidly with age
Elimination Disorders: Enuresis
1. Limitations imposed on social activities
2. Effects on self-esteem
3. Parental reactions
1. Limitations imposed on social activities
-can't sleep away from home
2. Effects on self-esteem
-including degree of social ostracism by peers
3. Parental reactions
-punishment anger rejection
Elimination Disorders: Enuresis: Causes
• Antidiuretic Hormone (ADH) Deficiency
• Genetics:
• Both parents 77%
• MZ: 68%
• Antidiuretic Hormone (ADH) Deficiency
helps urine [] so that there is less water and doesnt fill bladder up
Elimination Disorders: Enuresis: Treatments
• Behavioral:
• Bell & pad
• Dry bed training
• Meds
• Desmopressin(synthetic ADH)
• tricyclics
**meds not very good though bc the bed weting comes back once taken off meds
***having them hold it longer will
make it stronger...or hourly wakes to strip to the bathroom give a huge reward when one wakes up in dry bed
Elimination Disorders: Encopresis
passage of feces into inapprotriate places
involuntary or intentional
must be 4 y/o
• 2 subtypes:
• With or without constipation
• Overflow incontinence
Elimination Disorders: Encopresis
• 1.5-3%
• 5-6 times
• Decreases rapidly with age
• May feel ashamed & try to avoid situations (told public bathrooms are dirty)
Elimination Disorders: Encopresis: Causes
• Megacolon
• Defecation dynamics
• Megacolon
avoiding depressing or not recieving signals that have to go to bathroom gets clogged in there if uncleared the feces that stays in there becomes large hard and dry and future bowel movements bery painful
Elimination Disorders: Encopresis: Tx
• Fiber, enemas, laxatives or lubricants
• Behavioral methods
Chronic Illness
• Persists longer than 3 months
• Requires a period of continuous
hospitalization of more than 1 month
Chronic Illness: 2 Categories
1. Somatoform disorders:

2. Psychological factors affecting physical
somatoform disorders
• Somatization
• Hypochondriasis
• Pain Disorders
Substance Use Disorders
•Substance Dependence
•Substance Abuse
•Alters mood, perception or brain functioning
•Substance Dependence
•Substance Abuse
hazardous use; repeated probs in one yr in 1 or more
1. don't meet obligations
2. use in hazrdous situations
3. legal probs DUI
4. social or interperosnal probs
who is drinking the most
18-25 y/o and doing the most drugs
risk factor for later abuse and dependence is
age of 1st use
alcohol use before age __ is a strong predictor of subsequent abuse or dependence
girls __ boys to use
mj, alcohol, heroin, roids
girls more likely than boys to use
tranquilizers and amphetamines <-weight
Substance Abuse: Comorbidities
•Polydrug abuse
•Conduct disorder (95%)
•Attention deficits
•Anxiety disorders
•Mood disorders
Substance Abuse: Biological Context
-hard to parse out
•Prenatal Exposure
-also increases risk of adolecent use of alcohol and tobacco, one hypotheiss brain recpetors become sensitized to substances making child more reactive and crave
**difficult temperment**
Substance Abuse: Family Context
•Parental substance abuse
-modeling/social learning
•Parental depression
-maternal dperession, not alcoholism is precdicitive of alcohol use (the - effects of being emotionally unavailable palying a big role in development)
-paternal alcoholism
•Child maltreatment
(kid copes with this by abusing alcohol)
•Parenting style
-authoritative style the best to protect
peers are ___ predictor of adolescent drinking
most powerful
Substance Abuse: Social Context
•Peer relationships
-peer influence (normalizes subst. use also model introduce them to drug provide opportunites for continued use)
•Peer influence
•Peer selection
•Early sexual maturation
-esp with girls spend time with older peers that introduce them to violating behaviors such as subst abuse
those with low self esteem
attracted to drug use to gain status in peer group and make themselves feel better
Substance Abuse: Individual Context
•Conduct Problems
-early and agressive
-deviance, nonreligiousness, independence, critical of society
•Cognitive Schemas
•Emotion Regulation
protective factors
dont use substances likely to value academic achievement be unconcerned with independence from family accpet of social satus quo and involved in religion
Substance Abuse: Cultural Context
•Social Class
•Higher rates among ______ youths
high class
Substance Abuse: Risk Factors
-low expectation of success
-poor self esteem
-prob behaviors
-oriented toward peers
-poor school performance
Substance Abuse: Protective Factors
-concern about personal health
-intolerance toward deviance
-+ relationships w adults
-regulatory controls
-prosocial activities
-positive peer models
from use to abuse
social intergration
-reduces social support and increasing loneliness
-impedes successful function
-early marriage and child bearing divorce
criminal behavior
-steal DUI selling drugs
mental health
-psycosis increased suicidal ideation depresion
culture: availability of durgs; media
school: academic failure, lack of commitment to school
peer: early peer rejection, peer modeling
family: history of alcoholism
interindividaul: aggressive; conduct probs
difficutl temperment, hyperactive
eating disorders should not be confused with
disorderly eating
•Learning to eat is a process
•Requires precise coordination
•Young children often have troublesome eating habits
•Limited food preferences
•More common among girls
•Normal behavior
•Girls begin to have weight and appearance concerns at about age
•Perhaps due to socioculturalfactors
•But, this is normal too
Risk Factors
•Early Eating Habits
•Disturbed Eating Attitudes
•A person’s belief that cultural standards for attractiveness, body image, and social acceptance are based on one’s ability to control diet and weight gain
–Weight and Body Image Concerns
•Fear of gaining weight
•Distorted body image
More Risk Factors
•Transition into Adolescence
–Pubertal development
•Dieting and Weight Concerns
–60% of children in grades 5-8 reported having dieted in the past 7 days
–2/3 of mid-adolescent girls reported dieting during the past year
•10% are chronic dieters who remain on diets continuously or were on a diet at least 10 times
Biological Regulators
Biological processes that influence eating patterns
Biological Regulators (2)
•Metabolic Rate
–Balance of energy expenditure is established based on genetics and physiological makeup as well as eating and exercise habits
–Self-monitors and self-regulates behavior
•Set Point
–The body’s natural weight range
–Metabolic changes strive to keep weight at this point
Feeding Disorder of Infancy or Early Childhood
•Sudden or marked deceleration of weight gain in an infant or young child (under age 6) and a slowing or disruption of emotional and social development
•Can affect both physical and mental development and lead to death
Feeding Disorder of Infancy or Early ChildhoodPrevalence
•Up to 1/3 of young children
•Occurs with equal frequency in boys and girls
Feeding Disorder
•Onset before age 2
•No medical reason
•Outcome dependent on:
•When disorder is identified
•Degree of malnutrition
•Degree of developmental delay
•Severity of the infant-caregiver relationship
Feeding Disorder of Infancy or Early Childhood
•Closely tied to a poor infant-caregiver relationship
•Parental mental illness
•Associated with mothers who have a history of anorexia and disturbed eating habits
•As well as family disadvantage, poverty and unemployment
•Encourage positive interactions between parent and infant
•Smiling, talking and soothing
•Re-evaluation of infant’s feeding behavior
•The indigestion of inedible, non-nutritive substances for more than 1 month
•Often seen in very young and those with mental retardation
•Children still interested in eating normal foods
•At risk for developing bulimia as well as lead poisoning or intestinal obstruction
•More prevalent among children in institutions
•Institution: 9-25%
•Community: 0.3-15%
•The severity of Pica is dependent on the degree of mental retardation and lack of environmental stimulation
•May appear in normally developing infant or toddler
•Often environmentally deprived with poor stimulation and inadequate caregiver interaction
•Perhaps due to vitamin or mineral deficiency
•Ex: clay
•No genetic role with exception of cases of mental retardatio
•Emphasis on caregiver reinforcing appropriate behavior
•Encourage positive attention and interaction with child
•Vitamin supplements
•Food avoidance
–Marked anxiety of swallowing or choking
•May be triggered by incident of choking or witnessing someone choking
•No distorted image or preoccupation with weight and/or shape
•Equally affects males and females
Functional Dysphagia
•Profound refusal to eat or drink
–Will also not talk, walk or care for self
•Underweight and dehydrated. Life-threatening.
•May be diagnosed as anorexia nervosa
–But, appears to have more symptoms
–Possibly an extreme form of post-traumatic stress disorder or learned helplessness
Pervasive Refusal Syndrome
Both disorders have good prognoses if treated appropriately with multidisciplinary approach
Functional Dysphagia &Pervasive Refusal Syndrome
Our Culture obesity
•The conflict: Mass media powerfully promotes the thin ideal in a land where fast food is widely available and accessible
•In a comparison of 15 developed countries, the US had the highest percentage of obese children
•Child obesity increase of 3%-5% in 1990s
–10% increase among minority population
•Children whose BMI falls between the 85thand 95thpercentile are at risk for obesity
•15% of 6-11 year olds
•A child is considered obese if above the ___ percentile
•1960s: 5%
•1990s: 15%
•10% toddlers
•Meal portions
•Accessibility of fast food
•Convenience of junk food
•3 times more likely if both parents are obese
•40% if one sibling is obese
•Deficiency of Leptin
•Family factors
•Lack of limits, communication and support
•Poor eating habits
•Lack of exercise
•Changes in family functioning
•Increase parental knowledge
•Role models
•Teach self-control and monitoring
Anorexia Nervosa
“loss of appetite”
Subtypes of AN
Restricting Type
–Weight loss due to severe restriction of diet, fasting or excessive exercise
Binge-Eating/Purging Type
–Binge and purge on small amounts of food, unlike bulimia nervosa
Signs of AN
•Weight loss in a short amount time without known medical illness
•Ritualistic eating behavior
•Severe and selective restriction of food intake
•Active maintenance of low body weight
•Obsessive exercising
•Socially withdrawn, impaired concentration, irritability
Anorexia Nervosa
–Among adolescents: 0.3%
–Onset between 14-18 years old
–Often preceded by dieting
Subsequent Course
–Rate of mortality: 5%
–Less than ½ of survivors fully recover
–1/3 show some improvement
–In 1/5, the disorder is chronic and lifelong
Subtypes of BN 2
Purging Type
–Regular self-induced vomiting or laxative and diuretic misuse
•Majority of people with BN practice purging
•Induced vomiting most common among those seeking treatment
Non-Purging Type
–Excessive exercise or fasting
•The most common compensatory behavior among those not in treatment
Signs of BN
•Regular bingeing
–Episode of uncontrolled, rapid eating
•Regular purging
•Mood swings
•Weight not changing despite frequent exercise or consumption of large amounts of food
•Use of bathroom for long periods of time after meals
Signs of BN
Regular bingeing
–Episode of uncontrolled, rapid eating
•Regular purging
•Mood swings
•Weight not changing despite frequent exercise or consumption of large amounts of food
•Use of bathroom for long periods of time after meals
Bulimia Nervosa
–1-2% in 16-35 year olds
–Disproportionately female
–Onset usually late adolescence and young adulthood
•Slightly later than AN
–Usually starts in same way as AN
Subsequent Course
–50%-75% fully recover
Causes of AN and BN
•4-5 times more likely if a relative has AN or BN
•If identical twin has AN, 58%-88% chance of developing also
•Inherited personality traits
•Serotonin imbalance
–Physical appearance is key to:
–Cultural ideals
–Need to feel in control
»Rigid, “all-or-nothing” , black and white attitude.
»Restricting Type:highly controlled, rigid with obsessive tendencies
»Binge-Eating/Purging Type:impulsive behaviors, self-injuryand substance misuse.
–90% also have depression, anxiety disorders or OCD
Treatment of AN and BN
•Bulimia Nervosa
–Cognitive behavioral therapy
•Anorexia Nervosa
1.Help patient realize she/he needs help
2.Weight restoration
3.Family therapy and cognitive behavioral therapy
•Bingeing without compensatory behavior
•Coping mechanism for stress
•No need to be physically hungry
•In youth, 25% of those that meet ...criteria report attempted suicide
Binge Eating Disorder
Eating Disorders Not Otherwise Specified
•Partial Anorexia Nervosa
–Menstrual cycle is normal
–Body weight normal weight for age and height
•Partial Bulimia Nervosa
–The binge eating and compensatory behaviors occurs less than twice a week for 3 months
May be more appropriate for adolescents since are still not yet physically, cognitively and emotionally mature
• Child maltreatment
– Physical abuse
– Neglect
– Sexual abuse
– Emotional abuse
• Non-accidental trauma
– Wide ranging effects of maltreatment
Abuse or mistreatment of someone whose
ability to protect self is limited
• Victim wants to stop the violence, but longs
to belong to a family
• Affection & attention may coexist with
violence & abuse
• Intensity of violence increases over time
Types of Maltreatment: Physical Abuse
• Multiple acts of aggression
– Includes punching, beating, kicking, biting,
burning, shaking, or otherwise physically
harming a child
•Physical neglect
– Refusal or delay in seeking health care, expulsion from
the home or refusal to allow runway to return home,
abandonment, & inadequate supervision
•Educational neglect
– Allowing chronic truancy, failing to enroll a child in
school & failing to attend to a child’s special educational
•Emotional neglect
Inattention to needs for affection, refusal or failure to
provide needed psychological care, spousal abuse in
the child’s presence, & permission of drug or alcohol
use by the child
Maltreatment: Brain
•HPA axis
•Prefrontal cortex
•NT: Norepinephrine
Maltreatment: Resiliency & Adaptation
•Positive relationships with 1 important &
consistent person
•Positive self-esteem
•Positive sense of self
•Repeated acts or omissions by the parents or
caregivers that have caused, or could cause,
serious behavioral, cognitive, emotional or mental
Types of Maltreatment: Emotional Abuse