Child Patalogy Questions

ANXIATY DISORDER 1. What is anxiety disorder; explain it (3 points)
Anxiety is a mood state characterized by strong negative emotion and bodily symptoms of tension in which the child anxiously expects possible future danger or misfortune. This definition takes two key characteristics of anxiety—strong negative emotion and an element of fear. Children who experience excessive and debilitating anxieties are said to have anxiety disorders.

2. What are specific phobias in children, explain 2 specific phobias. (4 points)
DSM categorizes specific phobias into five subtypes, based on the focus of the phobic reaction and avoidance. These subtypes and the focus of fear of each are as follows:
• Animal. Animals or insects.
• Natural environment. Objects in the natural environment, such as heights, darkness, storms, or water.
• Blood–injection–injury. Seeing blood or an injury, or receiving an injection or other invasive medical procedure.
• Situational. A specific situation, such as flying in airplanes, riding in elevators, going through tunnels or over bridges, driving, or being in enclosed places.
• Other. Phobic avoidance of loud sounds or costumed characters, or of situations that may lead to choking, vomiting, or contracting an illness.

3. Explain panic attacks in children, explain symptoms for panic attack (3 points)
A panic attack is a sudden and overwhelming period of intense fear or discomfort that is accompanied by four or more physical and cognitive symptoms characteristic of the fight/flight response. Usually, a panic attack is short, with symptoms reaching maximal intensity in 10 minutes or less and then diminishing slowly over the next 30 minutes or the next few hours. Although they are brief, they can occur several times a week or month. It is important to remember that although the symptoms are dramatic, they are not physically harmful or dangerous. Panic attacks are extremely rare in young children. Symptoms are palpitations, pounding heart, sweating, trembling, sensations of shortness of breath, feeling of chocking, chest pain, nausea or abnormal distress, feeling dizzy, derealization (feeling of unreality), or depersonalization (being detected from oneself, fear of losing control, fear of dying.

4. Explain Posttraumatic stress disorders in children shortly. Explain the factors that can influence the process of recovery of children with PTSD (4 points)
Children with post-traumatic stress disorder (PTSD) display persistent anxiety following an overwhelming traumatic event that occurs outside the range of usual human experience. When the diagnosis of PTSD was first introduced, the reference points were catastrophic events, such as war, torture, rape, natural disasters (e.g earthquakes and hurricanes), and disasters of human origin (e.g., fires and automobile accidents). Three core features of PTSD:
1) persistent re-experiencing of the event,
2) avoidance of associated stimuli and numbing of general responsiveness, and
3) symptoms of extreme arousal

Cognitive–behavioral treatment involving imaginal or real-life exposure to feared stimuli has been shown to be a promising treatment for helping children with PTSD. 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 social support.

5. Explain your treatment approach in psychotherapy of children for one of anxiety disorder.(3 points)

MOOD DISORDERS 1. What is mood disorder and what are major types of mood disorders (4 points)
A mood disorder is in which a disturbance in mood is the central feature. Mood is broadly defined as a feeling or emotion, for example, sadness, happiness, anger, elation, or crankiness. Children with mood disorders suffer from extreme, persistent, or poorly regulated emotional states, such as excessive unhappiness or swings in mood from deep sadness to high elation. Mood disorders are one of the most common, chronic, and disabling illnesses in young people. There are two major types of mood disorders: depressive disorders and bipolar disorder.

2. What are key characteristics of major depressive disorder (MDD) (3 points)
DSM-IV clinical diagnosis requires presence of a major depressive episode, which is suggested by: * depressed mood/sadness most of the day, most days (in children and adolescents, may be irritable mood) * diminished interest or pleasure in activities * changes in appetite or weight * sleep disturbances * psychomotor retardation or agitation * fatigue or loss of energy * feelings of worthlessness or inappropriate guilt * difficulty thinking or concentrating * thoughts of death or suicidal ideation

3. What are the most often accompanying disorders to MDD (3 points)
Most common comorbid disorders are: anxiety disorders (separation anxiety and specific phobias) dysthymia, conduct problems, ADHD, substance use disorder. 4. What are main differences between MDD and Dysthymic Disorder (4 points)
Dysthymic is less severe but more chronic (depressed mood most of the day, most days, for at least 1 year) than MDD. In comparison to MDD, DD is associated with less anhedonia, social withdrawal, impaired concentration, death thoughts, and physical complaints, but more constant sadness, self-depreciation, low self-esteem, anxiety, irritability, anger, and temper tantrums. Children with both MDD and DD have “double depression”. Rates of DD are lower than MDD, with approximately 1% of children and 5% of adolescents affected. Most common comorbid disorder is MDD. It is more rare among preschool and school-age children, increases into adolescence and adulthood in MDD. DD is the most common age of onset 11-12 years (earlier than for MDD is 13- 15). Average episode length 2-5 years in DD. Average episode lasts 8 months, with almost all children eventually recovering; however a majority of children experience recurrences in MDD. 5. What are associated characteristic of depressive disorders, explain it briefly (3 points)
It interference with academic performance, but it is not necessarily related to intellectual deficits; it may have problems on tasks requiring attention, coordination, and speed, self perception, loss of interest, slowness of thought and movement. It can be cognitive disturbances: feelings of worthlessness, attributions of failure, self-critical automatic thoughts, depressive ruminative style, pessimistic outlook, hopelessness, and suicidal ideation. These kinds of people have low or unstable self-esteem. Self-esteem problems in adolescent girls are oft en related to a negative body image may partly contribute to their higher risk for depression .There are seen also social difficulties such as; few close friendships, feelings of loneliness and isolation, social withdrawal, ineffective coping in social situations. Poor relations with parents and siblings are seen at that people. Depression and suicide; the link between depression, suicidal behavior, and completed suicide is strong, and sobering. Poor concentration and thinking ability, agitation, fatigue, insomnia, and somatic complaints may lead to repeating a grade, being late or skipping school, failure to complete homework, and dissatisfaction with or refusal of school.

6. What are the causes of Depression, explain one that is the most important in accordance with your opinion (4 points)

a.) Genetic and family risk b.) Neurobiological influences c.) Family influences d.) Stressful life events e.) emotion regulation
Stressful life events: Depression is associated with severe stressful life events. These events may include a move to a new neighborhood, a change of schools, a serious accident or family illness, an extreme lack of family resources, a violent family environment, or parental conflict and or divorce. At times, nonsevere stressful events, or “daily hassles,” such as a poor grade on a test, an argument with a parent, criticism from a teacher, a fight with a boyfriend, or a broken date, may also result in depression. Triggers for depression oft en involve interpersonal stress or actual or perceived personal losses, such as the death of a loved one, abandonment, rejection, or a threat to one’s self-esteem. 7. Explain main characteristic of bipolar disorder(3 points).
There are periods of abnormally and persistently elevated, expansive, or irritable mood, alternating with one or more major depressive episodes. It may display symptoms such as over-excitement, restlessness, agitation, sleeplessness, and pressured speech, flight of ideas, sexual disinhibition, inflated self-esteem, and reckless behavior. There are several DSM subtypes, based on whether youngster displays a manic, mixed, or hypomanic episode. Extremely rare in young children, but increases after puberty (when rates are as high as for adults). It affects males and females equally. Most commonly comorbid with anxiety disorders, ADHD, conduct disorders, and substance abuse. It peaks age of onset between 15 and 19 years of age. Depression usually appears first.

INTELLECTUAL DISABILITY 1. What are main features of Children with intellectual disability in accordance to DSM-IV.(4 points)
Significantly sub-average DSM-IV-TR intellectual functioning with an IQ of approximately 70 or below on an individually administered IQ test (for infants, a clinical judgment of significantly sub-average intellectual functioning). Concurrent deficits or impairments in present adaptive functioning (i.e., the person’s effectiveness in meeting the standards expected for his or her age by his or her cultural group) in at least two of the following areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety. The onset is before age 18 years.

2. What are the main causes of intellectual disability of children? Explain one approach that is the most useful in your opinion(4 points)
The two-group approach emphasizes the important etiological differences between organic and cultural–familial causes of mental retardation. Organic mental retardation- includes chromosome abnormalities, single gene conditions, and neurobiological influences. Cultural-familial mental retardation- includes family history of mental retardation, economic deprivation, inadequate child care, poor nutrition, and parental psychopathology
In my opinion genetic and constitutional factors is the most useful for explaining intellectual disability: * Chromosomal abnormalities are the most common cause of severe MR. One of them is down syndrome. Down syndrome due to an additional 21st chromosome. * Fragile-X syndrome, the most common cause of inherited MR, is associated with the FMR-1 gene. Fragile-X syndrome has a more detrimental effect on males, causing mental retardation in most cases, compared to about half of females. * Prader-Willi and Angelman syndromes both associated with abnormality of chromosome 15; believed to be spontaneous genetic birth defects occurring around the time of conception. This lack of a gene or genes that are very close to each other appears to be the cause of the related syndromes. * Inborn errors of metabolism (referred to as single-gene conditions) can result in syndromes such as PKU. 3. Explain your critical opinion on use of IQ tests in diagnosis of children with disability (3 points)

4. What would be your approach in treatment of children with disability. Explain it (4 points)
Treatment involves a multi-component, integrated strategy that considers children’s needs within the context of their individual development, family and institutional setting, and community.
Psychosocial treatments those are intensive, child-focused. My approach is behavioral techniques include shaping, modeling, graduated guidance, and social skills training.
For many years the mode for dealing with problems faced by persons with mental retardation was to isolate them from society by placing them in institutions or separate schools, a practice that curtailed their ability to interact with typically developing peers. Efforts, coupled with continued input from parents and educators, led to a greater emphasis on positive methods for teaching basic academic and social skills in both schools and communities to help children and adolescents with mental retardation adapt in the most normal fashion.