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PSYC 3340 Midterm: Developmental Psychopathology Exam 3

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PSYC 3340

Ch 11-14, Trauma-Informed Care Anxiety and Obsessive-Compulsive Disorders Anxiety and Anxiety Disorders ● Internalized disorder - hard to find videos ● Anxiety: Mood state characterized by strong negative emotion and bodily symptoms of tension in anticipation of future danger or misfortune ○ 1) negative emotion ○ 2) physical tension ○ 3) apprehensive anticipation of danger ● Anxiety disorders involve experiencing excessive and debilitating anxieties ○ Occur in many forms ○ Normal human experience vs. functional impairment ● Many children with ADs suffer from more than one type ○ Anxiety disorders are among the most common mental health problems in children and adolescents, but they often go unnoticed and untreated ● Moderate amounts of anxiety helps us think and act more effectively ● Excessive, uncontrollable anxiety can be debilitating ● Bell curve of anxiety ○ Too little - don’t study, don’t do well on test ○ Average - study and handle test ○ Too much - can’t sleep, debilitated from studying ○ Normative vs. non-normative t ● Our biological system as it has developed… ○ No chemistry tests way back when ○ Ancestors were afraid of getting eaten or attacked by animals ■ Our fight/flight or freeze response is finely tuned to environmental effects ● Model of Anxiety ○ Two key features of anxiety: ■ 1) strong negative emotion ■ 2) element of fear ○ Anxiety ■ Thoughts ● Self-critical, bodily injury, images of harm to loved ones, thoughts of going crazy ■ Feelings ■ Behaviors ● Avoidance, trembling lip, swallowing, crying, nail biting, clenched jaw ■ Physical Sensations ● Increased heart rate, blushing, numbness, sweating, stomach upset ■ … Anxiety is an adaptive emotion that readies children both physically and psychologically for coping with people, objects, or events that could be dangerous to their safety or well-being ● Anxiety vs. Fear and Panic ○ Anxiety - future-oriented mood state ■ Hallmark - negative affect ○ Fear - present-oriented emotional reaction ■ Occurs in the face of a current danger and marked by a strong escape tendency ○ Panic - a group of physical symptoms of fight/flight response ■ Unexpectedly occur in the absence of obvious danger or threat Ch 11-14, Trauma-Informed Care ● Normal Fear, Rituals, Worries, and Anxieties ○ Moderate fear and anxiety are adaptive ■ Emotions and rituals that increase feelings of control and mastery over the environment are common in children and teens ■ Fears, worries, and rituals that are normal at one age can be debilitating a few years later ○ Involves an immediate reaction to PERCEIVED danger or threat ○ Fears, anxieties, worries, and rituals in children are common, change with age, and follow a predictable developmental pattern with respect to type ● 7 Categories of Anxiety Disorders ○ Separation Anxiety Disorder (SAD) ■ Brad is terrified of being separated from his mother. He follows her around the house constantly, always needing to know where she is. ○ Specific phobia ○ Social anxiety disorder (social phobia) ■ Sarah is very preoccupied with what others think of her. She doesn’t interact with anyone at school, and feels completely isolated ○ Selective mutism ○ Panic disorder (PD) ■ Claudia describes her sudden attack of overwhelming anxiety. “My heart started pumping so fast I thought it would explode. I thought I was going to die.” ○ Agroaphobia ○ GAD ■ Jared “worries about everything - how he is doing in school, events in the news, and family finances ○ OCD ■ No longer categorized as an anxiety disorder ■ George can’t stop thinking about not being able to sleep. Every night before bedtime she goes through the same routine of counting and grouping all the clothes and shoes in her bedroom closet and opening and closing the closet door ● SAD ○ Important for a child’s survival ■ It is normal from about age 7 months through preschool years ■ Lack of separation anxiety at this age may suggest insecure attachment ○ Distinguished by… ■ Age-inappropriate, excessive, and disabling anxiety about being apart from parents or away from home ■ One of the most common anxiety disorders of childhood, with the earliest reported age at onset and the youngest age at referral ○ Hallmark ■ Child needs parent with them more and more throughout development ○ Prevalence and Comorbidity ■ SAD is one of the two most common childhood anxiety disorders ■ 4-10% of children ● More prevalent in girls than boys ■ More than ⅔ of children with SAD have another anxiety disorder and about half develop a depressive disorder ○ School Reluctance and Refusal ■ Refusal to attend classes or difficulty remaining in school for an entire day Ch 11-14, Trauma-Informed Care ■ Occurs most often in ages 5-11 ■ Fear of school may be fear of leaving parents (separation anxiety), but can occur for many other reasons ■ Serious long-term consequences results if its remains untreated ● Specific Phobia ○ Age-inappropriate persistent, irrational, or exaggerated fear that leads to avoidance of the feared object or event and causes impairment in normal routine ■ Lasts at least 6 months ■ Extreme and disabling fear of objects or situations that in reality post little or no danger or threat ■ Child goes to great lengths to avoid the object/situation ○ Prevalence and comorbidity ■ 20% of children are affected at some points in their lives ● Few referred for treatment ■ More common in girls ○ Onset, course, outcome ■ 7-9 years ● Phobias involving animals, darkness, insects, blood, and injury ● Clinical phobias are more likely than normal fears to persist over time ○ Evolutionary theory contends that human infants are biologically predisposed to learn certain fears that alert them to possible sources of danger ■ This may explain why the most common specific phobia is a fear of animals, such as dogs, snakes, and insects ○ About 4-10% of children experience specific phobias, but only a very few are referred for treatment. ■ Can occur at any age, but seem to peak between 10 and 13 years of age ● Social Anxiety Disorder (Social Phobia) ○ A marked, persistent fear of social or performance requirements that expose the child to scrutiny and possible embarrassment ■ Anxiety over mundane activities ■ Most common fear is doing something in front of others ■ More likely than other children to be: ● Highly emotional ● Socially fearful ● Inhibited ● Sad ● Lonely ○ PCC - common ■ 6-12% of children ■ Twice as common in girls ■ ⅔ have another anxiety disorder ■ 20% also suffer from major depression and may self-medicated with alcohol and other drugs ■ Most common age of onset is early to mid adolescence, and is rare under age 10 ■ Average duration of symptoms is 20-25 years ○ Generally develops after puberty, at a time when most teens experience heightened self- consciousness and worries about what other think of them ● Selective Mutism Ch 11-14, Trauma-Informed Care ○ Failure to talk in specific social situations, even though they may speak loudly and frequently at home or other settings ○ 0.7% of children - rare ■ Prevalence does not seem to vary by sex or race/ethnicity ○ Onset 3-4 years ○ May be an extreme type of social phobia, but there are differences between the two disorders ■ Ex: speaks at home, but not at school ○ The most common co-occurring disorders are anxiety disorders, particularly SOC and specific phobia ○ Treatment ■ Similar to treatment for phobias ■ Ask the child to increase their volume of speaking slowly over time ■ Shape their behaviors so they use a normal speaking tone ● Panic Disorder (PD) ○ Panic attacks - hallmark ■ Sudden, overwhelming period of intense fear or discomfort accompanied by four or more physical and cognitive symptoms characteristics of the fight/flight response ■ Are rare in young children; common in adolescents ● Young children may lack cognitive ability to make catastrophic misinterpretations ● Adolescents with PD display recurrent unexpected panic attacks followed by persistent concern about having another attack, constant worry about the consequences, or a significant maladaptive change in their behavior related to the attacks, designed to avoid having additional attacks ■ Are related to pubertal development ○ Experience recurrent unexpected panic attacks ○ Followed by at least 1 month of persistent concern or worry about having another attack and its consequences and/or a significant change in behavior to avoid having another attack ● Agoraphobia ○ In severe cases, high anticipatory anxiety and situational avoidance may lead to agoraphobia ■ Fear of being alone in and avoiding certain places or situations ■ Fear of having a panic attack in situations where escape would be difficult or help is unavailable ■ Does not usually develop until age 18 or older ○ Prevalence and Comorbidity ■ Panic attacks are common - 16% of teens ■ Panic disorder is less common ● About 2.5% of teens 13-17 ■ Panic attacks are more common in adolescent females than adolescent males ■ Comorbid… ● Another anxiety disorder or depression ● At risk for suicidal behavior, alcohol or drug abuse ○ Onset, Course, and Outcome ■ Ages of onset for first panic attack 15-19 years ● 96% of PD adolescents are post-pubertal Ch 11-14, Trauma-Informed Care ● Lowest remission rate for any of the anxiety disorders ■ PD and agoraphobia are stable and over time and have one of the lowest rates of complete remission for any of the anxiety disorders ● GAD ○ Excessive, uncontrollable anxiety and worry ○ Worrying can be episodic or almost continuous ○ Worry excessively about minor everyday occurrences ○ Children with GAD experience chronic or exaggerated worry or tension, often accompanied by physical symptoms ○ Accompanied by… ■ Restlessness/feeling keyed up or on edge ■ Being easily fatigued ■ Difficulty concentrating ■ Irritability ■ Muscle tension ■ Sleep disturbances ■ Meta-worrying - worrying about worrying ○ Prevalence and Comorbidity ■ 2% lifetime prevalence rate ● One of the most common anxiety disorders in children who are referred to specialty clinics for treatment of anxiety ■ Equally common in boys and girls ■ Accompanied by high rates of other anxiety disorders and depression ○ Onset, Course, Outcome ■ Average age of onset is early adolescence ■ Older children have more symptoms ■ Symptoms persist over time ● OCD ○ Characterized by recurrent, time-consuming and disturbing obsessions and compulsions ■ Obsessions: persistent and intrusive thoughts, urges, or images, experiences as intrusive and unwanted; cause distress ● Most common - contamination and fears of harm to self and others ■ Compulsions: repetitive, purposeful, and intentional behaviors or mental acts performed to relieve anxiety ● Most common - washing and bathing, and repeating, checking, and arranging ○ Classified with tics and other impulse control disorders ○ Extremely resistant to reason ○ OCD children often involve family members in rituals ○ Normal activities of children with OCD are reduced, and health, social and family relations, and school functioning can be severely disrupted ■ Youngsters with OCD experience repeated, intrusive, and unwanted thoughts or obsessions that cause anxiety, often accompanied by ritualized behaviors or compulsions to relieve the anxiety ○ Prevalence and Comorbidity ■ Lifetime prevalence in children and adolescents is 1-2.5% ■ Clinic-based studies find it twice as common in boys ■ Comorbidities most common are other anxiety disorders, depressive disorders, disruptive behavior disorders Ch 11-14, Trauma-Informed Care ● Substance use, learning and eating disorders, vocal and motor tics are also overrepresented ● Trichotillomania, excoriation (skin-picking) disorder, hoarding disorder, body dysmorphic disorder ○ Onset, Course, Outcome ■ Average age of onset is 9-12 years with peaks in early childhood and early adolescence ● Children with an early onset are more likely to be boys and are more likely to have a family history of the disorder than are those with a later onset ■ Chronic disorder - as many as ⅔ continued to have OCD 2-14 years after initial diagnosis ● Associated Characteristics (Anxiety and Compulsion Disorders) ○ Children with anxiety disorders display a number of associated characteristics ■ Cognitive Disturbances ● Threat-related attentional bias, cognitive errors ■ Physical symptoms ● Somatic complaints, sleep problems ■ Social and emotional deficits ● Display low social performance and high social anxiety ■ Anxiety and depression ○ Children with anxiety disorders display deficits in specific areas of cognitive functioning, such as attention, memory, speech and language ○ They selectively attend to information that may be potentially threatening, a tendency referred to as “anxious vigilance” ○ These children often have somatic symptoms, such as stomachaches or headaches - also sleep disturbances ○ Children with anxiety disorders report being socially withdrawn and lonely, and may be viewed by others as socially maladjusted ○ There is a strong, undeniable relationship between anxiety and depression in children and adolescents ■ The difference between children who are anxious and those who are depressed ● May be the greater positive affectivity in those who are anxious ● Sociodemographic Correlates ○ Girls > boys ■ This difference is present in children as young as 6 years of age ○ Development and anxiety ○ Anxiety occurs across all cultures, but cultural lens affect the expression, developmental course, and interpretation of anxiety symptoms ■ Differing ethnicities and cultures may affect the expression and developmental course of fear and anxiety - as well as how you treat it ● Theories and Causes ○ Behavioral and Learning Theories ■ Classic psychoanalytic theory - views anxieties and phobias as defenses against unconscious conflicts rooted in the child’s early upbringing ■ Behavioral and learning theories - fears and anxieties were learned through classical conditioning ● Fears and anxieties learned through classical conditioning and maintained through operant conditioning Ch 11-14, Trauma-Informed Care ● Ex: Little Albert ● Two-factor theory ○ Bowlby’s Theory of Attachment ■ Early insecure attachments lead children to view the environment as undependable, unavailable, hostile, and threatening ■ Children who are separated from their mothers too early, who are treated harshly, or who fail to have their needs met consistently show atypical reactions to separation and reunion ○ Temperament and Behavioral Inhibition (BI): a low threshold for novel and unexpected stimuli ■ Place an individual at greater risk for anxiety disorders ○ Nature and Nurture ■ Anxiety response system in the brain and body ■ Parents of anxious children are seen as overinvolved, intrusive, or limiting child’s independence ○ Respondent vs. Operant Conditioning ■ Respondent Conditioning: a behavior elicited by an antecedent event ● Conditioned operants and conditioned emotional responses are established through respondent conditioning ● Dwight Altoid example ■ Operant Conditioning: a behavior is strengthened (evoked) by events which immediately follow it ○ Reinforcement ■ The process in which a behavior is strengthened by the immediate consequence that reliably follows its occurrence ■ Also referred to as the “reinforcement contingency” ■ Operant → Reinforcer → Operant is strengthened Ch 11-14, Trauma-Informed Care ■ Functional Definition of Reinforcement - ● All three pieces of the puzzle (over time) must be present to understand the process of reinforcement ○ What is the behavior? ○ What happened immediately after the behavior? ○ What happened to the behavior in the future? ○ Behavior → ? → ? ■ Positive vs. Negative Reinforcement ● Both positive and negative reinforcement strengthen behavior, but are distinguished by the nature of the consequence that follows the behavior ● Behavior → Immediate Removal of Stimulus (What constitutes a stimulus?) → Behavior is Strengthened ○ Section Summary: ■ Early theories viewed anxiety as a defense against unconscious conflicts, a learned response, or an adaptive mechanism needed for survival ■ Some children are born with a tendency to become over-excited and to withdraw in response to novel stimulation (BI) ■ Family and twin studies suggest a moderate biological vulnerability to anxiety disorders ■ Anxiety is associated with specific neurobiological processes ● The potential underlying vulnerability of children at risk for anxiety is most likely localized to brain circuits involving: ○ Brainstem, ○ the limbic system ○ the HPA axis ○ and the frontal cortex ■ Anxiety is associated with a number of family factors, including specific parenting practices, family functioning, the parent-child attachment, and parents’ beliefs about their children’s anxious behavior ● Treatment and Prevention ○ Best practice approach for treating anxiety disorders is exposing children to anxiety producing situations, objects, and occasions ○ Treatments are directed at modifying: ■ Physiological reactions to perceived threat ■ Excessive escape and avoidance behaviors ■ Distorted information processing ■ Sense of a lack of control ○ Behavior Therapy ■ Main technique is exposed to feared stimulus ● While providing children with ways of coping other than escape and avoidance ● Graded exposure ● “Fear rating” - thinking about spider vs. letting spider crawl on your arm ■ Subtypes of exposure therapy ● Flooding - prolonged (repeated) exposure ● Response prevention prevents child from engaging in escaping or avoidance stimuli ● Modeling and reinforced practice ■ CBT Ch 11-14, Trauma-Informed Care ● The most effective procedure for treating most anxiety disorders ● First line of treatment ● Teaches children to understand how their thinking contributes to anxiety, how to change maladaptive thoughts to decrease their symptoms, and how to cope with their fears and anxieties other than by escape and avoidance ● Skills training and exposure combat problematic thinking ○ FEAR Plan ■ F - Feeling frightened? ■ E - Expecting bad things to happen? ■ A - Attitudes and actions that can help ■ R - Results and rewards ○ For specific phobias - participant modeling and reinforced practice ○ Family Interventions ■ Addressing children’s anxiety disorders in a family context may result in more dramatic and lasting efforts ○ Medication ■ CBT is the first line of treatment ■ Medications should be used with caution ■ The most common and effective medications are SSRIs, especially for OCD ○ Prevention ■ Researchers identified children with a mean age of less than 4 years who were at-risk for later anxiety disorders ■ Intervention group (compared with a control group) showed fewer anxiety disorders and lower symptoms severity ■ Further research needed to evaluate their long-term benefits Ch 12 - Trauma and Stressor-Related Disorders ● Traumatic event - exposure to actual or threatened harm or fear of death or injury ○ Considered uncommon or extreme stressors ● Stressful event - less extreme, more common ○ Could be developmentally connected ■ Ex: starting school, leaving home for college ● Because children are dependent on the people who harm or neglect them, they face other paradoxical dilemmas as well: ○ The victim not only wants to stop the violence, but also longs to belong to a family ○ Affection and attention may coexist with violence and abuse ○ The intensity of the violence tends to increase over time, although in some cases physical violence may decrease or even stop altogether ● DSM5 Recognition ○ Included disorders: ■ Acute Stress Disorder ■ Adjustment Disorder ■ Reactive Attachment Disorder ■ Disinhibited Social Engagement Disorder ■ PTSD ● Child Abuse and Neglect ○ Child Maltreatment is considered among the worst and most intrusive forms of trauma and stress ○ Four primary acts of child maltreatment: Ch 11-14, Trauma-Informed Care ■ 1) Physical abuse ■ 2) Neglect ■ 3) Sexual abuse ■ 4) Emotional abuse ○ Non-accidental trauma: wide-ranging effects of maltreatment on the child’s physical and emotional development ○ Victimization: abuse or mistreatment of someone whose ability to protect himself or herself is limited ○ Overview ■ Paradoxical dilemmas ● Safety vs. Belonging ○ The victim wants to stop the violence but also longs to belong to the family in which they are being abused ● Affection and Attention ○ Both may coexist with violence and abuse ● Maintain Power and Control ○ Abusive behavior may vary in a relationship, but adult abuse of power is the main issues ○ History and Family Context ■ History ● Major cultural traditions have condoned abuse of family members ○ Absolute authority over the family by the husband ● 1989 Convention on the Right of Children ○ Spurred efforts to value the rights and need of children, to recognize their exploitation and abuse in developed countries ● Policy Changes ○ Today, 42 countries have established an official government policy regarding child abuse and neglect ■ Family ● Understanding the Impact of Trauma on Kids ○ We must first understand healthy family environments ● Healthy parenting includes: ○ Knowledge of child development and expectations ○ Adequate coping skills for caregivers ○ Ways to enhance development through stimulation and attention ○ Opportunities to foster normal parent-child attachment and communication ○ Expectable environment ○ Trauma and Stress ■ Trauma and stressful experiences in childhood or adolescence may involve: ● Actual or threatened death or injury, or a threat to one’s physical integrity ● Children exposed to chronic or severe stressors (ex: major accidents, natural disasters, sexual abuse, war, etc.) have an elevated risk of PTSD ○ Continuum of Care ■ Child care can be described along a hypothetical continuum ranging from healthy to abusive and neglectful ■ Positive end - appropriate and healthy forms of child-rearing actions that promote child development Ch 11-14, Trauma-Informed Care ■ Middle range - poor/dysfunctional actions represent irresponsible and harmful child care ■ Negative end - parents who violate their children’s basic needs and dependency status in a physically, sexually, or emotionally intrusive or abusive manner, or by neglect ○ How Stress Impacts Children ■ Stressful events impact each child in different and unique ways ● Hyperresponsive reactions ● Hyporesponsive reactions ● Allostatic Load: progressive “wear and tear” on biological systems due to chronic stress ○ Maltreatment ■ Neglect ● Physical Neglect: Refusal or delay in seeking health care, expulsion from the home, or refusal to allow a runaway to return home, abandonment, and inadequate supervision ● Educational Neglect: Allowing chronic truancy, failing to enroll a child of mandatory school age in school, or failing to attend to a child’s special education needs ● Emotional Neglect: Marked inattention to a child’s need for affection, refusal or failure to provide needed psychological care, spousal abuse in the child’s presence, and permission of drug/alcohol use by the child ■ Physical abuse ● Multiple acts of aggression ○ Punching, kicking, beating, biting, burning, shaking, or otherwise physically harming a child ● Injuries are often the result of over discipline or severe physical punishment ● Physically abused children are often described as more disruptive and aggressive ■ Psychological (Emotional) abuse ● Repeated acts or omissions that may cause serious behavioral, cognitive, emotional, or mental disorders ○ Extreme forms of punishment, verbal threats, name-calling ● Exists in all forms of maltreatment ● Can be as harmful as to a child’s development as physical abuse or neglect ■ Sexual abuse ● Include fondling a child’s genitals, intercourse with the child, incest, rape, sodomy, exhibitionism, and commercial exploitation through prostitution or the production of pornographic materials ● May significantly impact behavior, development and physical health of sexually abused children ● Reactions and recovery of sexually abused children vary, depending on the nature of the assault and responses of important others ○ Many acute symptoms resemble children’s common reactions to stress ■ Exploitation ● Commercial or sexual exploitation Ch 11-14, Trauma-Informed Care ○ Child labor and child prostitution ● Significant form of trauma for children and adolescent worldwide ○ As many as ten million children may be victims of child prostitution, the sex industry, sex tourism, and pornography ○ Childhood trauma may involve actual or threatened death or injury, or a threat to one’s physical integrity ○ Forms of childhood stress that may lead to poor adaptation: ■ Bullying ■ Parental separation ■ Peer conflict, etc. ○ Chronic stress challenges the child’s developing biological and social development ○ Many forms of child trauma, stress, and maltreatment are connected to poverty and inequality, social isolation, and unhealthy cultural norms concerning child-rearing practices and family privacy ○ Boundaries between appropriate and inappropriate behavior towards children are not always clear or well established, but an awareness of what is right and what is wrong can go a long way in preventing maltreatment ● Characteristics of Children Who Suffer from Maltreatment ○ Age ■ Younger children are more at risk for abuse and neglect ■ Sexual abuse is more common among older age groups (over 12) ■ (Except for sexual abuse), the victimization rate is inversely related to the child’s age ○ Sex ■ 80% of sexual abuse victims are female, but with that exception, boys and girls are victims of maltreatment almost equally ○ Racial characteristics ■ The majority of substantiated maltreated victims are white (44%) AA (22%) or Hispanic (21%) ■ Compared to children of same race or ethnicity in the US ● Highest rates of victimization are children who are !!, American Indian or Alaska Native, and multiple race… White, Hispanic and Asian are lowest ● Reactive Attachment Disorder (RAD): characterized by a pattern of disturbed and developmentally inappropriate attachment behaviors, likely due to social neglect in early childhood ○ When faced with a new form of stress, children with RAD show no consistent effort to seek comfort or nurturance from their caregiver, and fail to respond to their caregiver’s efforts to comfort them ○ Seldom express positive affect ○ Failure to make secure attachments ○ Linked to problems in the early caregiver-child relationship, which could be due to multiple caregivers, social neglect or deprivation, or being reared in an institution with very limited opportunities to develop secure attachments ○ Children show little effort to seek comfort from a caregiver or adult ● Disinhibited Social Engagement Disorder (DSED): characterized by a pattern of overly familiar and culturally inappropriate behavior with relative strangers, due to social neglect ○ Unlike RAD, children with DSED fail to check with caregivers and may venture away Ch 11-14, Trauma-Informed Care ○ May exhibit intrusive and overly familiar behavior with strangers, including asking overly personal questions, violating personal space, or initiating physical contact without hesitation ○ Must include socially disinhibited behavior - not due to impulsivity ○ Prevalence and Development ■ Children ages 9 months - 5 years ■ Prevalence unknown ● Believed to be uncommon even among populations of severely neglected children ■ RAD in early childhood has been linked to subsequent internalizing disorders such as depression, whereas DSED has been linked to disruptive behavior disorders such as ADHD ○ Causes and Treatment ■ Typically recover once placed in a stable, secure environment - RAD ■ DSED shows more lasting difficulties than RAD ■ Children with either RAD or DSED show developmental delays that may persist for several years ● PTSD ○ For Children 6 and Younger ○ Associated Problems and Adult Outcomes ■ PTSD can become a chronic psychiatric disorder for some children and youth ● May persist for decades ○ In some cases for a lifetime ● Children and youth with chronic PTSD may display a developmental course marked by remission and relapses ● In a less common delayed variant, children exposed to a traumatic event may not exhibit symptoms until months or years later ○ Causes of PTSD in children focus on psychological factors (such as emotional regulation and their view of self and others), as well as neurobiological factors that affect various brain areas and reactivity to stress ● Mood and Affect Disturbances ○ Symptoms of depression, emotional distress, and suicidal ideation are common among children with histories of all types of abuse ■ Teens with histories of maltreatment have a much greater risk of substance abuse ■ Childhood sexual abuse also can lead to eating disorders, such as anorexia and bulimia ○ In reaction to emotional and physical pain from abusive experiences… ■ Children/adults voluntarily or involuntarily may induce an altered state of consciousness known as dissociation ● Dissociation allows one to feel detached from the body or self, as if what is happening is not happening to him/her ○ Sexual Adjustment ■ Sexual abuse can lead to traumatic sexualization… ● A child’s sexual knowledge and behavior are shaped in developmentally inappropriate ways ○ Ex: open masturbation, genital exposure, hugging and kissing of stranger adults, promiscuous behavior ● How Trauma Impacts Functioning Ch 11-14, Trauma-Informed Care ○ Poor Emotion Regulation ■ Maltreated toddlers/infants have difficulty establishing reciprocal, consistent interaction with caregivers ● Exhibit insecure-disorganized attachment ● Have difficulty understanding, labeling, and regulating internal emotional states ● Learn to inhibit emotional expression and regulation, remaining more fearful or alert ○ Emerging View of Self and Others ■ Emerging views of self and surrounding are not fostered by healthy parental guidance and control ● Emotional and behavioral problems are likely ● Negative representational models of self and others develop based on a sense of inner “badness,” self-blame, shame, or rage ■ Feelings of powerlessness and betrayal are internalized as part of their self- identity ● Maltreated girls show internalizing signs of distress ○ Shame and self-blame ● Maltreated boys show externalizing problems ○ Heightened levels of verbal and physical aggression ○ Neurobiological Development ■ Children and adults with a history of child abuse show long-term alterations in the HPA axis and norepinephrine systems ● These alterations have a significant effect on responsiveness to stress ● Affected brain areas include the hippocampus, prefrontal cortex, and amygdala ■ Acute and chronic forms of stress associated with maltreatment may cause changes in brain development and structure from an early age ● The neuroendocrine system becomes highly sensitive to stress ○ Causing neurobiological changes that may account for later psychiatric problems ○ Expectable Environment: ■ External conditions or surroundings that are considered to be fundamental and necessary for healthy development ● Infants - protective and nurturing adults, opportunities for socialization ● Older children - supportive family, contact with peers, ample opportunities to explore and master environment ● Prevention and Treatment ○ Several factors appear to be important in children’s course of recovery from PTSD, including the nature of the traumatic event, preexisting child characteristics, and family/social support ○ Obstacles to intervention and prevention services for maltreating families ■ Those most in need are least likely to seek help ■ Parents do not want to admit to problems for fear of losing their children or being charged with a crime ○ Exposure-Based Therapy ■ Following acute stress or trauma… ● Early exposure intervention has reduced acute stress symptoms ■ Many of these interventions are brief, ranging from 1-10 sessions Ch 11-14, Trauma-Informed Care ● Are often delivered in groups to reach as many children as possible ■ Ex: Psychological First Aid (PFA) ■ In depth psychological interventions ● The child typically begins by describing a particular traumatic incident and their feelings and thoughts about it ■ Types: ● Grief and Trauma Intervention for Children ● Trauma-Focused CBT (TF-CBT) ○ Involves a combo of exposure therapy and skill building to allow the individual to practice more effective ways of coping with intrusive memories and emotions ○ Prevention of maltreatment holds considerable promise, especially if attempts are begun early in the formation of the parent-child relationship ○ Treatment of physical abuse involves training parents in more positive child-rearing skills, accompanied by CB methods to target specific anger patterns or distorted beliefs ○ Treatment for neglect focuses on parenting skills and expectations, coupled with training in social competence and household management ○ Interventions for children who have been sexually abused emphasize the children’s needs for safety, understanding, and expression of emotional consequences ○ CB methods have shown value in working with sexually abused children, especially when accompanied by education and support for non offending, supportive caregivers ● Special Needs for Maltreated Children ○ Interventions for physical abuse usually improve ways to change how parents teach, discipline, and attend to their children ○ Treatment for child neglect focuses on parenting skills and expectations, coupled with teaching parents how to improve their skills in organizing important family needs ○ Treatment programs for children who have been sexually abused provide several crucial elements to restore the child’s sense of trust, safety, and guiltlessness ○ TF-CBT has been adapted for child sexual abuse victims and others with complex trauma symptoms Ch 13: Health-Related and Substance-Use Disorders ● History ○ For centuries, poorly understood physical symptoms have been misattributed to psychological causes ○ Today, pediatric health psychologists study how children’s health-related problems interact with their psychological well-being and how they and their families adapt in response ● Professional Psychology ○
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