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318 Cards in this Set
- Front
- Back
• A developmental brain disorder
• Affects social functioning |
Autism
|
|
Autism:___increase in pediatric prevalence
between 1991-1997* why? |
556%
• 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 • PDD/NOS |
pervasive developmental disorder (PDD)/autism spectrum disorder (ASD)
|
|
more common in boys
|
Autism
|
|
no language impairment, highly functional
|
Asperger syndrome
|
|
more common in girls
|
Rett syndrome
|
|
develop fine, then regress
|
Childhood Disintegrative Disorder
|
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don't meet all the criteria
|
PDD/NOS
|
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Time Trends: Autism
|
Significant increase in prevalence
|
|
Now: ~____ per 10,000 (US)
|
30-60
|
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1960s: ~___ cases per 10,000
|
4
|
|
Why the increase?
|
– Improved diagnostic ascertainment
– Broadening of diagnostic concept – Environmental factors cannot be excluded |
|
Autism: A developmental disorder
• Diagnosed between age ___ • Usually because |
2-5
kids fail to show age-typical behavior (fail to speak!) |
|
• First signs at around ___ months; obvious by
___years. |
12-24
24mo-6 |
|
Boys:girls ___
|
4:1
|
|
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 |
|
Symptoms
|
• 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 gestures) • Delay or absence of language production & comprehension • 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 |
50%
|
|
Gestures: _____but not ______
|
instrumental
expressive |
|
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 routine |
|
Associated characteristics: IQ
|
• Can span the entire range but
|
|
• ____% mental retardation
|
70%
(IQ < 70) |
|
__average or above average IQ
|
30 %
|
|
• ___have splinter skills
|
25%
|
|
___autistic savants
– The real “rainman” • Read by 16 months • By age 4 memorized 8 encyclopedias!!! |
5%
|
|
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 |
Hyper/Hyposensitivity:
|
|
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 |
3-4
|
|
Cognitive Deficits: Executive Functioning
– Problems with |
• Higher order planning and regulation of
behaviors – 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
pieces. |
|
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 different. |
|
Genes & Autism
• single gene? • As many as ___ genes involved • Heritability __% • ___ risk among siblings • Monozygotic twins: ____ • Dizygotic twins: ~___ |
• Most strongly genetic psychiatric disorder of
childhood! • Not just a single gene 15 90% 2-6% 36-91% 10% |
|
Environmental influences
|
• Pre/perinatal complications
– Infections, teratogens (Alcohol, Thalidomide), prematurity,problems during birth • 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
beginning • Rate of growth very fast - larger than normal head size •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 |
|
Treatment
|
• Early diagnosis & intervention is KEY.
experience can change the way the brain “wires up” • 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 stories 4.Behavior & Communication Therapy: • DTT •Speech Therapy •Picture Exchange Communication Systems (PECS) |
|
Sensory Integration
Therapy (SIT) |
involves: Listening to sounds,
touching things goal: Help individuals deal with sensory stimulation |
|
Play Therapy & Social
stories |
Involves : Child controlled adult-child interaction
Goal: Improve emotional development, social skills and learning |
|
Behavior & Communication
Therapy: • DTT •Speech Therapy •Picture Exchange Communication Systems (PECS) |
Involves: •Learning appropriate
behaviors •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 situations. • 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 behavior. • Using rewards specific to the child |
|
PECS
|
-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
|
Paranoid
Disorganized Catatonic Undifferentiated and Residual |
|
delusions of persecution or grandeur
intensely emotional or very formal |
Paranoid type
|
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silliness and incoherence
insensitivity to external cues hypersensitivity to internal cues |
Disorganized-
|
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enormously excited or strikingly frozen
negativism (oppositional behavior) |
Catatonic-
|
|
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-
|
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major impairment in the understanding of reality
|
Psychosis
|
|
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 |
|
COS:
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
|
depression
ADHD 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
developmental dopamine stress |
|
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 |
|
acute
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,
haloperidol 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) |
stressor
|
|
is how the body meets the stressor
|
allostasis
|
|
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
|
pharmacological
psychosocial intervention |
|
______ control psychotic symptoms,
but have unacceptable side effects over time |
neuroleptics
|
|
_________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
|
sensation
|
|
how brain organizes sensation
|
perception
|
|
In the Shining
Tony= girls= |
Tony=delusion
girls=hallucination |
|
- 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
|
phonological
|
|
– Speech fluency
|
stuttering
|
|
– Using spoken language to communicate
|
expressive language disorder
|
|
– Understanding what other people say
|
mised expressive perceptive
|
|
– Reading
|
dyslexia
|
|
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
|
interpersonal
|
|
recognise define and pursue inner feelings and thoughts
|
intraperosnal
|
|
meaning function and gramatical rules of words
|
linguistic
|
|
1. Approach learning in different ways
2. Tailor educational methods 3. Strengthen existing abilities |
Important Concepts
|
|
basic sounds building blocks of words (ba, da)
|
phenomes
|
|
how many phenomes are there
|
44
|
|
___ 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
|
babble
|
|
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"
Babbles 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
months 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
|
50-70%
|
|
In communications disorders they have a prob with the ___part of the brain
|
left
|
|
part of the brain important for language
|
left
|
|
___ is important for speech comprehension
-prob for receptive |
wernicke's
|
|
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
|
stuttering
|
|
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 movements |
|
Stutterers:
|
diff in perslvian region (houses wernicke's area)
-dopamine -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 knowledge |
Dyslexia
|
|
core deficit in reading disorders
|
decoding
|
|
ID WORDS WITH SPEED AND ACCURACy
|
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)
|
|
inversions
|
m/w , u/n
|
|
ommisions
|
place instead of palace
|
|
constant updating task
|
control group does better than dyslexia , prob w working memory
|
|
most common learning disorder
|
dyslexia
|
|
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 |
-read
-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 -anxiety -depression -frustration |
|
5 Stages of Sleep:
|
•Non-REM:
Stage 1 Stage 2 Stage 3 Stage 4 •REM |
|
REM
|
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
|
infant
|
|
executive functioning, spending more time in the later part of the night in REM
|
frontal cortex
|
|
Health Related Disorders: Sleep Disorders
•Dyssomnias |
•Protodyssomnia
•Hypersomnia •Narcolepsy •Breathing-related Sleep Disorder •Circadian rhythm Sleep Disorder |
|
Health Related Disorders: Sleep Disorders
•Parasomnias |
•Nightmare Disorder
•Sleep Terror Disorder •Sleepwalking Disorder |
|
like insomnia
|
•Protodyssomnia
|
|
tired alot
|
•Hypersomnia
|
|
all of sudden fall asleep collapse and fall directly into REM
|
•Narcolepsy
|
|
Sleep Disorders: Dyssomnias
Protodyssomnia |
-difficulty initating or maintaining sleep or sleep that is not restorative
-infants repetitive night waking and inability to fall asleep |
|
Sleep Disorders: Dyssomnias
Protodyssomnia prevalence |
25-50% of 1-3 year olds ...prett common in infants
|
|
Sleep Disorders: Dyssomnias
Protodyssomnia treatment |
behavioral treatment
family guidance |
|
Sleep Disorders: Dyssomnias
•Hypersomnia |
excessive sleepiness
|
|
Prevalence & Age:
•Hypersomnia |
Common among young children
|
|
•Hypersomnia
•Treatment |
•Behavioral treatment
•Family guidance |
|
•Narcolepsy
|
attacks of sleep
-cataplexy-loss of muscle tone...not forever though |
|
•Narcolepsy
•Prevalence & Age: |
•<1%
|
|
•Treatment•Narcolepsy
|
•Structure
•Support •Psychostimulants •SSRIs |
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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
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•Prevalence & Age:
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•Unknown
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•Treatment
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•Behavioral treatment
•Chronotherapy |
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Sleep Disorders: Parasomnias
•Nightmare Disorder |
happens during REM, repeating aweakenings with recall of dreams VERY FRIGHTENING
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Sleep Disorders: Parasomnias
•Nightmare Disorder •Prevalence & Age: |
•Common between ages 3 & 8
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•Treatment
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•Provide comfort
•Reduce stress |
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•Sleep Terror Disorder
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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 |
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•Sleep Terror Disorder
•Prevalence & Age: |
•3% ages 18 months to 6 years
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•Treatment
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•Reduce stress & fatigue
•Add late afternoon nap helps relieve stress |
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Sleep Disorders: Parasomnias
•Sleepwalking Disorder •Prevalence & Age: |
•15% 1 attack
•1-6% 1-4 attacks per week |
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•Treatment
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•Take safety precautions
•Reduce stress & fatigue •Add late afternoon nap |
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Can look like other things
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ADHD
learning difficulties aggression cognitive deficits substance abuse depression anxiety |
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Elimination Disorders: Enuresis
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-involuntary discharge or urine
-over 5 y/o |
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Enuresis
• 3 Subtypes: |
1. Noctural only
2. Diurnal only 3. Noctural + diurnal |
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• Prevalence:
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• 13-33% of 5 y.o. wet their beds
• More common |
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enuresis more common
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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) |
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course
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declines rapidly with age
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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 |
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Elimination Disorders: Enuresis: Causes
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• Antidiuretic Hormone (ADH) Deficiency
• Genetics: • Both parents 77% • MZ: 68% |
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• Antidiuretic Hormone (ADH) Deficiency
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helps urine [] so that there is less water and doesnt fill bladder up
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Elimination Disorders: Enuresis: Treatments
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• 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 |
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***having them hold it longer will
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make it stronger...or hourly wakes to strip to the bathroom give a huge reward when one wakes up in dry bed
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Elimination Disorders: Encopresis
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passage of feces into inapprotriate places
-clothing involuntary or intentional must be 4 y/o |
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Encopresis
• 2 subtypes: |
• With or without constipation
• Overflow incontinence |
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Elimination Disorders: Encopresis
Prevalence: |
• 1.5-3%
• 5-6 times |
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Course:
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• Decreases rapidly with age
• May feel ashamed & try to avoid situations (told public bathrooms are dirty) |
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Elimination Disorders: Encopresis: Causes
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• Megacolon
• Defecation dynamics |
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• Megacolon
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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
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Elimination Disorders: Encopresis: Tx
Treatment: |
• Fiber, enemas, laxatives or lubricants
• Behavioral methods |
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Chronic Illness
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• Persists longer than 3 months
• Requires a period of continuous hospitalization of more than 1 month |
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Chronic Illness: 2 Categories
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1. Somatoform disorders:
2. Psychological factors affecting physical condition: |
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somatoform disorders
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• Somatization
• Hypochondriasis • Pain Disorders |
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Substance Use Disorders
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•Substance Dependence
•Substance Abuse •Self-administration •Alters mood, perception or brain functioning |
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•Substance Dependence
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addiction
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•Substance Abuse
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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 |
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who is drinking the most
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18-25 y/o and doing the most drugs
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risk factor for later abuse and dependence is
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age of 1st use
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alcohol use before age __ is a strong predictor of subsequent abuse or dependence
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14
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girls __ boys to use
mj, alcohol, heroin, roids |
<
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girls more likely than boys to use
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tranquilizers and amphetamines <-weight
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Substance Abuse: Comorbidities
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•Polydrug abuse
•Conduct disorder (95%) •Attention deficits •Anxiety disorders •Mood disorders |
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Substance Abuse: Biological Context
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•Genetics
-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 |
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•Temperament
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**difficult temperment**
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Substance Abuse: Family Context
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•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 |
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peers are ___ predictor of adolescent drinking
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most powerful
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Substance Abuse: Social Context
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•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 |
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those with low self esteem
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attracted to drug use to gain status in peer group and make themselves feel better
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Substance Abuse: Individual Context
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•Conduct Problems
-early and agressive •Unconventionality -deviance, nonreligiousness, independence, critical of society •Sensation-seeking •Cognitive Schemas •Enhancement •Social •Coping •Conformity •Emotion Regulation |
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protective factors
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dont use substances likely to value academic achievement be unconcerned with independence from family accpet of social satus quo and involved in religion
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Substance Abuse: Cultural Context
•Social Class •Higher rates among ______ youths •Factors: |
high class
•Media |
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Substance Abuse: Risk Factors
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•Personality
-low expectation of success -poor self esteem -hopelessness -alienation •Environmental -prob behaviors -oriented toward peers •Behavioral -poor school performance •Social -antisocial |
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Substance Abuse: Protective Factors
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•Personality
-+orientation -concern about personal health -intolerance toward deviance •Environmental -+ relationships w adults -regulatory controls •Behavioral -prosocial activities •Social -positive peer models |
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from use to abuse
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social intergration
-reduces social support and increasing loneliness occupation -impedes successful function family -early marriage and child bearing divorce criminal behavior -steal DUI selling drugs mental health -psycosis increased suicidal ideation depresion |
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culture
school peer family interindividaul intraindivdual |
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 intraindivdual: difficutl temperment, hyperactive |
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eating disorders should not be confused with
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disorderly eating
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•Learning to eat is a process
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•Requires precise coordination
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•Young children often have troublesome eating habits
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•Limited food preferences
•More common among girls •Normal behavior |
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•Girls begin to have weight and appearance concerns at about age
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9
•Perhaps due to socioculturalfactors •But, this is normal too |
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Risk Factors
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•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 |
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More Risk Factors
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•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 |
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Biological Regulators
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Biological processes that influence eating patterns
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Biological Regulators (2)
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•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 |
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Feeding Disorder of Infancy or Early Childhood
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•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 |
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Feeding Disorder of Infancy or Early ChildhoodPrevalence
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•Up to 1/3 of young children
•Occurs with equal frequency in boys and girls |
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Feeding Disorder
Development |
•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 |
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Feeding Disorder of Infancy or Early Childhood
Causes |
•Closely tied to a poor infant-caregiver relationship
•Neglect •Abuse •Parental mental illness •Associated with mothers who have a history of anorexia and disturbed eating habits •As well as family disadvantage, poverty and unemployment |
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Treatment
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•Encourage positive interactions between parent and infant
•Smiling, talking and soothing •Re-evaluation of infant’s feeding behavior |
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Pica
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•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 |
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Pica
Prevalenc |
•More prevalent among children in institutions
•Institution: 9-25% •Community: 0.3-15% |
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Development
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•The severity of Pica is dependent on the degree of mental retardation and lack of environmental stimulation
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Pica
Causes |
•Unclear
•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 |
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Treatment
|
•Emphasis on caregiver reinforcing appropriate behavior
•Encourage positive attention and interaction with child •Vitamin supplements |
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•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
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•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
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Both disorders have good prognoses if treated appropriately with multidisciplinary approach
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Functional Dysphagia &Pervasive Refusal Syndrome
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Our Culture obesity
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•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 |
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•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 |
95%
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Obesity
Prevalence |
•1960s: 5%
•1990s: 15% •10% toddlers |
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Development
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•Meal portions
•Accessibility of fast food •Convenience of junk food |
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Obesity
Causes |
Causes
•Genetics •3 times more likely if both parents are obese •40% if one sibling is obese •Deficiency of Leptin •Family factors •Parenting •Lack of limits, communication and support •Diet •Poor eating habits •Lifestyle •Lack of exercise |
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Treatment
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•Changes in family functioning
•Increase parental knowledge •Role models •Encouragement •Teach self-control and monitoring |
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Anorexia Nervosa
|
“loss of appetite”
|
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Subtypes of AN
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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 |
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Signs of AN
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•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 |
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Anorexia Nervosa
Prevalence |
–Among adolescents: 0.3%
–Disproportionatelyfemale •11:1 |
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Development
|
–Onset between 14-18 years old
–Often preceded by dieting |
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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 |
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Subtypes of BN 2
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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 |
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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 |
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Bulimia Nervosa
Prevalence |
–1-2% in 16-35 year olds
–Disproportionately female •30:1 |
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Development
|
–Onset usually late adolescence and young adulthood
•Slightly later than AN –Usually starts in same way as AN |
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Subsequent Course
|
–50%-75% fully recover
|
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Causes of AN and BN
|
–Genetics
•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 –Neurobiological •Serotonin imbalance Social –Physical appearance is key to: •Happiness •Self-worth •Femininity •Success –Cultural ideals Psychological •Characteristics –Need to feel in control –BN »Rigid, “all-or-nothing” , black and white attitude. –AN »Restricting Type:highly controlled, rigid with obsessive tendencies »Binge-Eating/Purging Type:impulsive behaviors, self-injuryand substance misuse. |
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•Comorbidity
|
–90% also have depression, anxiety disorders or OCD
|
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Treatment of AN and BN
|
•Bulimia Nervosa
–Cognitive behavioral therapy –Antidepressants •Anorexia Nervosa 1.Help patient realize she/he needs help 2.Weight restoration 3.Family therapy and cognitive behavioral therapy |
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•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
|
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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 |
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• Child maltreatment
|
– Physical abuse
– Neglect – Sexual abuse – Emotional abuse |
|
• Non-accidental trauma
|
– Wide ranging effects of maltreatment
|
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Victimization
|
Abuse or mistreatment of someone whose
ability to protect self is limited |
|
Considerations
|
• 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 |
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•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 need |
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•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 |
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Maltreatment: Brain
|
•HPA axis
•Hippocampus •Prefrontal cortex •Amygdala •NT: Norepinephrine |
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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 disorders |
Types of Maltreatment: Emotional Abuse
|