PSY 602 Final: Developmental Psych FINAL Review
21 Nov 2016
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Developmental Psychopathology Final Exam Review
Anxiety, Trauma, Substance Abuse, Mood Disorders & Autism
Anxiety Disorders
Introduction
- Anxiety is future oriented immediate response with perceptions of uncontrollability over aversive events,
fear is an alarm reaction to a present threat and panic is symptoms of anxiety in absence of perceived threat
- Anxiety is maladaptive when fear is unrealistic, out of proportion, persist and experience anticipatory
anxiety
- Anxiety leads to fight (confront) or flight (avoid), exposure in sympathetic system increases to panic peak
and then decrease in parasympathetic through habituation
- Somatic symptoms are tense muscles, adrenalin and increased heart rate, emotional symptoms are
restlessness and terror, cognitive symptoms are anticipation and exaggeration of fear, and behavioral
symptoms are avoidance and aggression;
- First fear is strangers > separation > dark > ghosts/thunder > tests/death > relationships/school
(adolescence)
- By 6 girls are 2x more likely (genetic), ^ rates of SAD in Hispanics and social anxiety/performance for
Chinese
- Specific Phobia: fear that is excessive and unreasonable for specific object or situation which is avoided or
endured with extreme anxiety; animals, natural environment, situational, blood injection injury and other;
girls, most common diagnosis, meet criteria for more than 1 disorder (anxiety/depression)
- Separation Anxiety: excessive fear involving separation, 3+ symptoms including worry about harm, refusal
to leave, fear being alone, can’t sleep, nightmares, etc; combined with GAD, leading to social anxiety
- School Reluctance/Refusal: refuse to attend school + somatic complaints (stomach ache), 5-11 years onset,
may follow a stessor (bullying), break from school or link to separation anxiety, maintained by negative
reinforcement; classify based on functional analysis (function behavior serves) rather than symptoms
- Selective Mutism: failure to speak in specific situation despite speaking in other situations
- Obsessive Compulsive Disorder: obsessions are persistent thoughts/impulses/images that are intrusive and
most people recognize that these are products of their own mind (ex. harm, contamination, safety),
compulsions are repetitive behaviors to try to prevent or reduce anxiety about obsession (ex. checking,
cleaning, hoarding); co-occurs with Tourettes and tic disorders
- Generalized Anxiety Disorder: excessive anxiety about many events, as well as concern about performance
leading to perfectionism, most common in adolescence, common in girls; in adolescence co-occurs with
depression or social anxiety, in children with separation anxiety
Theories For Anxiety
- Biological: environment turns vulnerable genes on, GABA/seratonin/norepinephrine neurotransmitters,
limbic system (amygdala), overactive BIS, PANDAS (infection > inflamed cells of basal ganglia > OCD)
- Developmental Psychopathology: behavioral inhibition (avoidance) > anxiety, greater autonomic reactivity,
elevated morning cortisol and heightened startle response > anxiety, fight-flight-freeze higher in social
anxiety and panic
- Psychodynamic: anxiety results from suppressed inner conflict which must be reduced by defense
mechanisms
- Behavioral: fear of object develops through classical conditioning
Factors Relating to Anxiety
- 4 cognitive characteristics of GAD are intolerance of uncertainty, erroneous belief about worry (it helps),
poor problem orientation (problem = threat), and cognitive avoidance
- Attachment problems arise if child is separated too early or treated harshly, leads to relationships being
viewed as threatening > anxiety
- Parental rejection and over-control, parental modeling, lack of emotional responsiveness, prolonged
exposure to anxiety > ^ prevalence in middle childhood, 2.7% increased risk with parental history, 4.7% if
current
- High BI > social anxiety in context of maternal over-control, + insecure attachment = even higher risk
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Treatment
- Psychological Treatment: first line for behavior and cognitions, CBT to teach children to recognize thoughts
with use of FEAR (feeling, expecting, attitudes/actions, results/rewards)
- Medication: SSRIs mostly effective for OCD/social/SAD/GAD, improves symptoms > psychological treatment
- Behavioral: exposure therapy, systematic desensitization, fear hierarchy, flooding; 75% success
Trauma
Childhood Trauma Through Abuse
- 25% of children before 16, polytrauma > single, 5 children each day die by caregiver maltreatment
- Traumatic events are less common and is exposure to actual harm, (abuse) stressors are less extreme
(bullying)
- Child Maltreatment: failure to act or an act of caregiver resulting in harm or death, abuse of power, 14/1000
in Canada, mostly neglect; relational as it tends to occur in context of child rearing demands
- Neglect: physical, emotional and educational, when stressed parents avoid interactions, leads to little
enthusiasm in toddlers and poor impulse control and dependent in preschool
- Physical Abuse: aggression usually due to overdiscipline, due to hostile attribution bias, way of maintaining
control, decreased knowledge on parenting, stressors > child habituating to physical punishment + negative
reinforcement from parents saying that punishment works > ^ in child problem behavior
- Emotional Abuse: acts causing behavioral/cognitive/emotional/mental disorders, exists in all types of
maltreatment
- Sexual Abuse: touching, intercourse, exploitation, most underreported
- Most offenders male/isolated/low self esteem/psychiatric disorder and substance abuse/history of
abuse/low white matter in cortex
- Most victims are vulnerable, spend time alone and are unsure of themselves
- Sexual abuse leads to early puberty onset, mental disorders, HPA stress response, obesity, drop out,
teen motherhood, substance abuse and increased risk for offspring maltreatment
- Lower ages for physical/emotional, over 12 for sexual, for girls by someone they know and for boys by
stranger; higher rates in disabled (3x) and poor due to limited child care, crowded homes, lack of health
care, etc
- Acute Stress Disorder: not longer than 1 month, immediate trauma response
- Reactive attachment disorder (rarely seek comfort) and disinhibited social engagement disorder
(comfortable with strangers) are both reactions to social neglect
PTSD
- Exposed to actual event, threatened event, direct or witnessed, heard about it, extreme indirect exposure
- 1/3 of children exposed to traumatic event are diagnosed with PTSD, especially in girls
- Intrusion symptoms include memories, nightmares and dissociative reactions (flashbacks, re-enact)
- Avoidant symptoms include avoidance of internal (memories) and external (places/people) stimuli
- Cognitive and mood symptoms include inability to remember, negative beliefs, blaming, detachment and
negativity
- Arousal and reactivity symptoms include irritability, outbursts, recklessness and lack of sleep and
concentration
- Begins 3 months after trauma and lasts 1+ month
- Flashbacks enacted in nightmares, recall enacted in play, developmental regression, aggression, lowered
academics
- PTSD is mediator linking trauma to psychopathology; moderators include type of stressor (chronic and
abusive over acute and non-abusive), multiple forms over single, negative coping, parent response, etc
- Co-morbidities include depression, anxiety, substance abuse, eating disorder and LD’s
- Cognitive responses include denial through fantasy and not understanding permanence of death (pre-
school), making play self into hero and difficulty concentrating (school age), and capacity for understanding
events (adolescence)
find more resources at oneclass.com
find more resources at oneclass.com
