Quiz 3 Suicide, Ptsd, Cd, Odd, Practice/reactive Aggression, Rad,adhd

Front 1

*SUICIDE risk factors

Back 1

DRAMATIC INCREASE IN LAST DECADE
RISK FACTORS:
low self esteem
high risk taking
family history
life stressors
PROTECTIVE FACTORS
family cohesion
absence of family history
peer support

Front 2

*SUICIDE

Back 2

8x more than in 1950's
Boys 5x more likely to COMMIT suicide
3rd leading cause of death in 10-19 year olds
girls more likely to ATTEMPT suicide

Front 3

*SUICIDE risks

Back 3

Risks:
novelty seeking
low self esteem
family history
peer relationships
alcohol use
stressful life events that include teen pregnancy
physical sexual abuse
parental conflict
unwelcome relocation

Front 4

*SUICIDE protective factors

Back 4

-Three protective factors can reduce probability by 70-80%.
-Treatment programs (SOS)
-Immediate and multilayered school response is important.

Front 5

*PTSD

Back 5

-appeared in the DSM 1980
-under trauma and stressor disorders in DSMv
-Much greater awareness that symptoms can occur in children.
-impact of trauma can be far reaching and long standing.
-symptoms vary from SURVIVOR GUILT AND CONCENTRATING in teens, to AGITATION and DISORGANIZED BEHAVIORS IN children.

Front 6

*PTSD diagnosis

Back 6

-identification of traumatic event far beyond what most experience in a lifetime.
-at least 6 symptoms from three symptom clusters.
-duration of disorder must be at least one month.
-separate criteria for children <6
-no longer required that subject have intense fear, helplessness, or horror. An event such as an accident can now be part of PTSD. More kids being diagnosed because of this.

Front 7

*PTSD challenges to diagnosing in youth

Back 7

-what is traumatic for you?
-how do symptoms present at different dev. levels?
-young children may confuse appearance and reality
-event may not seem catastrophic but still have significant later repercussion such as sexual touching.

Front 8

*PTSD features in children

Back 8

May include:
-traumatic images
-re experiencing
-increased agitation and arousal
-emotional numbing IS NOT COMMON.

Front 9

*PTSD developmental issues/characteristics

Back 9

-diff. symptoms at different levels
-depressive symptoms in grades 4-6 and 11-12
-Emotional distress seen in grades 7-12
-Early onset is <14. Associated with interpersonal problems.
-Late onset is 14>. Associated with greater academic problems.

Front 10

*PTSD developmental issues/characteristics

Back 10

-school aged children may engage in repetitive trauma play, symptoms likely present at home and at school, problems with bedtime routines, instead of numbing they may show restlessness at school, poor concentration, hyper vigilance, difficulties learning.
-school aged may also show signs of ADHD.

Front 11

*PTSD adolescent

Back 11

-especially vulnerable to a traumatic event/change in normal development trajectory. (an event may change your trajectory, the path you had planned to take)
-more likely than children or adults to respond with impulsive and aggressive behavior/may reenact trauma events into life.

Front 12

*PTSD risk factors

Back 12

-severity of traumatic event
-physical or temporal proximity to the event
-personal impact
-child's age or stage of development
-mental health status
-manner in which parents respond

Front 13

*PTSD risk factors

Back 13

Nature of traumatic event:
greater the trauma, the greater likelihood of symptoms of PTSD

Front 14

*PTSD TYPE 1 TRAUMA

Back 14

one time occurrence produces more typical PTSD with re-experiencing, avoidance.

Front 15

*PTSD TYPE 2 TRAUMA

Back 15

Repeated sexual or physical abuse likely to elicit numbing, dissociation, rage.

Front 16

*PTSD COMPLEX TRAUMA

Back 16

Term proposed for use with children due to complicated and numerous differences from adults. Children not only suffer from trauma but also the post traumatic environmental adaption.

Front 17

*PTSD PROXIMITY

Back 17

The degree related to how close the child was to the traumatic event. However, children may develop symptoms from witnessing neighborhood violence.

Front 18

*PTSD PARENT RESPONSE

Back 18

Either positive or negative. Parent who is overwhelmed or distressed may be less sensitive to child needs.

Front 19

*PTSD CHILD'S NEEDS

Back 19

Other risk factors: tv coverage, previous exposure to trauma, negative emotionality, poverty

Protective factors: low family stress, education, mental health

Youngsters exposed to Buffalo Creek Dam collapse met PTSD criteria 17 years later.

Front 20

*PTSD PREVALENCE

Back 20

-Prevalence for children difficult to obtain
-adult prevalence is 8%
-6% IN MASSACHUSETTS ADOLESCENT SAMPLE
-With sexually abused children up to 44%
-Boys may not be recognized as clearly as girls because instrument emphasize internalizing symptoms.

Front 21

*PTSD BIOLOGICAL FACTORS

Back 21

-a number of biological factors
-cortisol
-sympathetic and parasympathetic nervous pathways
-highly stressful events may change body and brain chemistry
-behavioral model focuses on continued negative thoughts.

Front 22

*PTSD Parenting style

Back 22

withdrawn/unresponsive and overprotective results in worsening of symptoms, fearful pattern result in increased avoidance.

Front 23

*PTSD Cognitive Behavioral Therapy

Back 23

Eye movement desensitization and reprocessing, anxiety management training, imaginal and in vivo exposure.

Front 24

*PTSD Interventions for complex trauma

Back 24

They should include safety/ self regulation/ self-reflection/development of coping skills/ interpersonal relationships/ positive effect

Front 25

*REACTIVE ATTACHMENT DISORDER RAD
prevalence

Back 25

considered rare with only 10% of severely neglected children.

Front 26

*RAD characterized by:

Back 26

pattern of markedly disturbed and developmentally inappropriate attachment behaviors

Front 27

*RAD essential feature

Back 27

absence or grossly underdeveloped attachment between child and caregiving adults.

Front 28

*RAD before age 5 is be because of neglect and deprivation.

Diagnosis should be cautious after 5 years old.
Does not meet criteria for autistic spectrum disorder.

Back 28

RAD DIAGNOSTIC CRITERIA is a consistent pattern of emotionally withdrawn behavior toward adult caregivers.
MUST HAVE 2 OF THE FOLLOWING:
minimal social and emotional responsiveness to others
limited positive affect
episodes of unexplained irritability or sadness

Front 29

*DMDD disruptive mood dysregulation disorder

Back 29

MAIN FEATURE: temper or anger outbursts with underlying persistent irritability disproportionate to the situation and unrelenting over a 12 month period. (these are kids they say are bipolar)

children over 6 years.

Front 30

*DMDD Intent is to distinguish from bipolar disorder

Back 30

-research does not indicate that children who are diagnosed with bipolar go on to develop bipolar in adulthood. The brain changes from child to adult, so meds will change, too, or they won't need them.

Front 31

*DMDD
-children will not have bipolar disorder label as an adult. It hasn't been helpful to have this label, too many kids on medication.

Back 31

-In effect, bipolar may only be 1% of children; not very common.
-Change in approach largely due to concern with medication prescribed and potential effect upon the brain, since the brain changes with transition into adulthood.

Front 32

*DMDD symptoms:
-severe, chronic temper outbursts, verbala aggression, or emotional storms that are out of proportion to situation.

-outbursts occur an average of 3xs per week.

-they occur for 12>months

Back 32

-irritability does not remit when stressors are gone.
-observed in at least 2/3 settings and severe in at least one.
-diagnosis cannot be made before 6 or after 18 (look at the child's developmental level, not chronological)

Front 33

*DMDD symptoms:
-historical assessment finds that symptoms were present before 10.

Back 33

-do not occur as a result of major depressive disorder or other disorder (anxiety, ptsd, etc.)

Front 34

*DMDD severe disorder:
-50% will continue to have chronic irritability one year later.
-causes disruption in family, difficulties in school, problems with relationships with peers.
-may be dangerous behaviors like aggression, suicide attempts.

Back 34

-self harm is common as is hospitalization
-ODD (oppositional defiant disorder) is most commonly combined with DMDD
-behavior should be inconsistent with child's age and developmental level.
-cannot be better explained by autism spectrum disorder.

Front 35

*WHY IS DMDD LIKELY TO REPLACE THE DIAGNOSIS OF BIPOLAR DISORDER (EXCEPT IN A FEW CASES WHERE TWO POLES CAN TRULY BE OBSERVED)?

Back 35

The distinguishing of DMDD in children and the removal of Childhood Bipolar Disorder from the DSM comes after much observation. It is typical to see these outbursts in children as they are externalizing behaviors but, the other 'pole' of depression was rarely observed.

Front 36

*PROACTIVE AGGRESSION

Back 36

-premeditated aggression
-'cold-blooded' with low or little emotion
-reward driven
-Bandura's Social Learning Model (suggests likely they've seen it somewhere)

Front 37

*REACTIVE AGGRESSION

Back 37

-'hot blooded' with high emotional involvement
-activated by the autonomic nervous system
-increased by frustration or lacy of self control
-early patterns of self dis-regulation
-likely to be tied to temperament

Front 38

*ODD oppositional defiant disorder:
persistent, hostile, defiant, disobedient, and negative pattern of behaviors directed towards authority figures and include at least 4 of the following symptoms:

Back 38

1. loss of temper
2. argumentative w/adults, confrontational
3. defiant; refuses to comply with requests
4. deliberately annoying
5. blames others for mistakes or problems

Front 39

*ODD symptoms con't…
6. touchy or easily irritated
7. angry and resentful
8. spiteful and vindictive

Back 39

-Dx must come before age 18
-2% to 16% more common in males
-lasts longer than 6 months.

Front 40

*CD conduct disorder:
repetitive and persistent behavioral pattern which involves the violation of social norms or violation of the rights of others and include at least 3 of the following:

Back 40

1. bullies; threatens
2. initiates fights
3. use of weapons to cause harm
4. cruelty to others and animals
5. theft while confronting
6. forced sexual activity

Front 41

*CD behaviors con't…
7. fire setting with intent to harm
8. property destruction
9. break-in
10. cons others
11. theft
12. out all night
13. run away
14. frequent truancy

Back 41

-1%-10%, much more common in males
-symptoms must be present for 12 months
-shows little remorse or empathy.

Front 42

*THE DIFFERENCE BETWEEN ODD AND CD IS:
ODD is associated with overt and nondestructive behaviors, while CD is linked to overt and covert behaviors which can be destructive and violate the rights of others.

Back 42

CD is more impacting than ODD.
ODD has earlier onset than CD.
Aggressive behavior = ODD and delinquent behaviors = CD.

Front 43

*ADHD (3-9% of the population)
Ratio of males to females: 2:1 to 9:1
30% drop out of school
Co-morbidity is high: 30% depression, 25%-75% meet criteria for ODD or CD

3 Specifiers are:
Inattentive type
hyperactivity impulsive type
combined type

Back 43

Type 1 Inattentive
1. problems sustaining attention, distracted, disorganized, forgetful, poor focus
2. Diagnosed less than the other two
3. Research suggests FEMALES PRIMARILY HAVE THIS TYPE.

Front 44

*ADHD Specifiers con't

Back 44

Type 2 hyperactivity
1. fidgety, excess movement, on the go, loud
2. diagnosed earlier
3. 90% of all diagnosed ADHD
4. Problems socially and academically

Front 45

*ADHD specifiers con't

Back 45

Type 3 combined
1. meet both criteria
2. most severe of the other two.

Front 46

*2 types of UNIPOLAR DEPRESSION:
Persistent Depressive Disorder PDD
Major Depressive Disorder MDD

Back 46

PDD
-less intense form of depression, fewer symptoms, lasting one year in children without relief for two months.
-depressed mood lasting most of the day, on most days
-averages 2-4 years
-risks factors include parent loss or separation

Front 47

*MDD major depressive disorder

Back 47

MDD
-depressed mood state or loss of pleasure in everyday activities lasting at least 2 weeks
-average length is 4 months

Front 48

*Unipolar Depression (PDD and MDD) risk factors:

temperament, low self esteem, family conflict, maternal depression, peer rejection, poverty, stressful life event.

Back 48

Protective Factors:

increased attentional control, high academic achievement, family cohesion, supportive peers

Front 49

*BIPOLAR DISORDER 1 and 2

-experience both lows of depression (MDD) and highs of mania (euphoria)

Back 49

Bipolar 1
- MDD and manic (1 wk. abnormal elevated mood)

Bipolar 2
-MDD and hypomanic (less severe)

Front 50

*SUICIDE
SOS program is for prevention, empirically shown to be effective.

associated with low levels of serotonin in both depression and suicide.

Back 50

-ACKNOWLEDGE the signs of suicide and take them seriously

-Let the person know you CARE about them and that you want to tell

-Then TELL a responsible adult