PSYC330 Exam 2 Study Guide.docx

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PSYC 330
Andrea Chronis- Tuscano

OPPOSITIONAL DEFIANCE DISORDER & CONDUCT DISORDER Oppositional Defiance Disorder (ODD) Evidence Based Treatment- ODD/CD - Hostile, defiant, lose temper, social impairment - Not psychotic or mood disorder Parent Child Interaction Therapy (PCIT)- uses in vivo coaching to provide individual parent support and feedback in - Can have both CD or APD, and ODD in DSM5 session Negative Affect- angry and irritable, later depression - Parents have to meet mastery to advance in tx, one Defiance- noncompliant, later behavioral disorder family gets one therapist Conduct Disorder (CD)- more serious, very apathetic Anger Control Training w/ Stress Inoculation (cognitive - Repetitive behavior where violate rights of others/ method)- explosive reaction from deficit in youth’s norms understanding of what sparks angry arousal (help understand causes and consequences) - Aggression, destruction of property, deceitful - Teach coping and provide exposure to provocation - Lack of behavioral inhibition (likes dangerous activities, and in vivo practice seek rewards, less sensitivity to danger) - Antisocial Personality Disorder (APD) not present Strategies - Strong parental history of APD, but less response to tx - Insert time delay btwn stimulus/ response - Ignore provocation, relax Gender Diff - Assertiveness training - Boys rate 2-4x higher, earlier age onset, greater - Problem solving skills training persistence [b/c testosterone, hostile attribution bias differs. CD/ODD criteria emphasize physical - Cognitive controls: self-instruction, self-evaluation, aggression] think ahead Anger Coping Program (age 9-13) - Rate diff dec in adolescence then inc again (apparent - Live and video modeling, immersion in problem by 4 years old) solving skills - Girls more involved in relational aggression - Set weekly goals + monitor ODD  CD - ODD is a precursor so symptoms overlap but many w/ Multidimensional Tx Foster Care- community based ODD won’t have CD later program for severe delinquency in adolescence, placed in foster care for a few months - Most w/ CD had ODD, but half didn’t meet ODD criteria - attain weekly therapy for anger management, problem - 40% go on to develop APD (callous and unemotional solving, social skills traits) - promote reintegration w/ real parents (parents receive More Symptoms: verbal deficits, learning problems, self- behavioral training) esteem deficits (inflated, unstable), peer and family problems Multi Systematic Therapy- combines tx for serious antisocial Childhood onset CD: ADHD, poor academic achievement, behavior - cog/ beh approaches, behavior therapy, parent executive function deficits, parental psychopathology, family training, medical intervention discord, insecure attachment, early peer rejection - provided in home, better than community tx Adolescent Onset CD: socialized, strong envi contribution, more girls than in early onset, 9 CORE PRINCIPLES wrote on paper Comorbidity- 50% have ADHD, 1/3 have depression/anxiety disorder Social Cognitive Model- stimulus event and youth perception - ADHD+CD is dangerous more aggressive, great of event, based on learning history and selective attention persistence, earlier onset of CD - consequences of aggression ChildAnxiety Triggered ChildAvoidance Parental Reassurance Parental DifferentialAttention Anxious behavior is negatively reinforced, only Positive reinforcement for approach behavior short term and can cause social anxiety disorder Ignore anxious/ avoidance behavior Ex. Hugs, verbal reassurance Ex. Eye contact, smile, show interest Parent Removes Demand Parent as Coach talk to the child, leaves area that triggered anxiety Convey confidence in child’s abilities Gradual exposure help child overcome feared situation ChildAnxiety MAINTAINED ChildAnxiety REDUCED Parent avoids putting kid in anxious situation Parent continues to use gradual exposure and differential attention ANXIETY DISORDERS 3 Interrelated Systems Prevalence 5-15% & chronic when untreated - Physical: inc heart rate, upset stomach, muscle tension - high comorbidity among childhood anxiety disorders - Behavioral- avoidance, cry/ scream, nail biting, - significant impairment (school, family, peers) tantrums Development and Maintenance of Anxiety Disorders - Cognitive- thoughts of being scared/ hurt, worry, though Behavioral Inhibition- type of temperament- risk factor for developing later anxiety of incompetence 1. Separation Anxiety Disorder- childhood, anxious from - Low threshold to novelty and withdrawal from novel being apart from parents/ home stimuli to infancy • One of the most common disorders - Tendency to be fearful and anxious as toddlers Stable inhibition across infancy and early childhood predicts • 2/3 have comorbid anxiety disorder, 50% later develop adolescent social anxiety disorder depression - Risk can be moderated by overprotective parenting • Onset: 7-8 years, not as normative - More extreme response in infancy leads to future • 1/3 persist into adulthood shyness 2. Social Phobia/ Social Anxiety- Fear of social/ performance - Predisposition is inherited situations that expose child to judgment and embarrassment Cognitive- enhanced attention to threat • Worry about negative evaluation - Perception of threat activates dangerous thoughts and • 1-3% negative evaluation • peak onset is early to mid-adolescence responses - Interpret ambiguous cues as threatening 3. Generalized Anxiety Disorder- worry about many events/ Biological: Neurobiological influences activities on most days that lasts at least 6 months - HPAAxis- regulation of stress, cortisol excretion • Excessive and uncontrollable anxiety and somatic - Limbic System (amygdala)- larger volume in this area, components (physical/ behavior/ cognitive troubles) overactivity • Onset 10-14 years (3-6%) - Brain Stem- danger signals 4. Panic Disorder- no clear reason for attack, unexpected recurrent panic attacks and worry about future panic attacks Assessment of Anxiety Disorders of implications of attacks Cognitive Behavioral Therapy  very effective for most anxiety disorders, first line tx • Symptoms NOT physically harmful, w/ or w/o - 70-80% experience reductions in anxiety agoraphobia (don’t leave their homes) • 1% of teens, onset 15-19 yrs (95% postpubertal) - Medications (SSRIs) combined w/ CBT indicative for more pervasive/ impairing disorders (OCD) • Lowest remission rate for anxiety disorder more - Restructure cognitions by doing feared activities severe o Use coping self-talk, investigate evidence, • Evidence Based Treatment: exposure to panic experience habituation symptoms (physical sensations) to provoke anxiety  Behavioral strategies: modeling, in vivo exposure, o Interoceptive Exposure- initiate feelings of role play, reinforced practice, relax training panic attack (learn habituation, fears won’t Show that I can (STIC) Task- practice skills taught in therapy happen) outside session 5. Obsessiv
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