Atypical Child and Adolescent Development

Exam I Study Guide Chapters 1, 2, 4, 5

Be familiar with the following terms, individuals, and concepts:

Chapter 1 - Introduction to Normal and Abnormal Behavior in Children and Adolescents

Characteristics of dysfunctional families as highlighted in class. How are they different from each
other?
o Perfectionist family All things have to be perfect, appearance and behavior. Lots of pressure,
many kids break and cant sustain.
o Driven to success family Kids used as merit badges. Want kids to be in as many
extracurricular activities as possible so they can brag. Kids under a lot of pressure. Kids will
either submit to it and sustain the pressure or break, which can cause a rift in the family.
o Apathetic family - Parents dont care not that they dont know how to be parents. Whatever
happens to kids is seen as their choice, no one feels like family members, they feel like
roommates. Only have shelter and food. The parents are completely uninvolved.
o Chaotic family No rules, guidelines for anyone. Members are free to be whatever they want.
Come and go as you want, no one in charge. Children become self-conscious and unpredictable.
Children get married early. Kids can sometimes place themselves in charge. Parents fear their
kids wont like them if they put rules.
o Angry family Family ruled by anger, threats. Not necessarily physically violent. Could be father
and/or mother. Authoritarian. Lacking emotional support, lots of emotional abuse. Kids hide
their feelings because if they share them they are discounted or made fun of. Kids then have a
hard time getting close to people.

What are the most salient variables a clinician should consider during the assessment process with
children/adolescents?
o Kids often lack social skills, and a lot of assessment depends on the age of the child. You have to
watch interactions between the child and the parents, sometimes the parents believe the child
to be abnormal but theyre wrong. Have to be conscious of the gender of the child. Girls are
twice as depressive as boys in adolescence. Have to take the duration of the issue into account,
have to take how disabling/disruptive the problem is for the child. Ethnicity also has to be taken
into account.

What were the psychological contributions of the following notable historical figures ?
o John Locke Children should be treated with kindness, which was a novel thought back then
because children were often treated as property. He thought children were being mistreated,
and thats why there was a lot of mental issues with children. Also believed children should
receive an education.
 o Jean Marc Itard Known most for Victor of Avignon, who was a feral child. Raised in the
wilderness. Found at around age 12 in the woods around Paris. He tried to educate and civilize
the boy. First time anyone did something like this for a special needs child. Boy didnt like
clothes, liked to drink water like a dog. Since the boy was 12 when found, language was a very
hard thing for him to master. Was able to understand a few words, but could not use it
meaningfully. When the child was taken away to an asylum, he reverted back to being very
feral.
o Dorothea Dix American activist, spearheaded campaigns to reform the asylums of her day,
back in the civil war era. Asylums were in very bad shape, and the people inside of them were
treated horribly (chained, beaten). Went around the USA to talk to legislators about reforming
the asylums, and succeeded.
o Leta Hollingworth Studied gifted children, she coined the term gifted. High IQ children,
about140. Came up with curriculums that worked for gifted children. Worked a lot with
feminine psychology, she disproved the notion that since womens brains were smaller that
they were less intelligent.
o Clifford Beers Everyone in his family had some kind of a psychological disorder. He paid a lot
of attention to their issues. He concluded that all these people needed was not to be
incarcerated, but to have someone to talk to and figure out their problems with. Formed first
outpatient facility.
o Benjamin Rush Considered the first psychiatrist. Lived in the revolutionary war era, first to
come up with the notion that mental illness was not because of possession by a demon, but
that something was wrong with the person's brain. Thought that mental illness was caused a lot
by circulation issues. Civic leader in Philadelphia, humanitarian, etc.
o John Watson Father of behaviorism, ran the Little Albert experiment, where they created a
fear response in a little boy using a white mouse. The reason people behaved the way they do is
not because of anything internal, did not believe in the subconscious. He thought it was all
about behaviors and reinforcement.
o Sigmund Freud Best known for his term psychoanalysis, catharsis, free associations. First
to delve into the idea of the subconscious. Constructed the psyche, the id, the ego, and the
superego. Id is the primal part, fueled by aggression and self-centeredness, like a baby. The
superego is the opposite, where all the rules of society and the family are stored. The ego is
the arbitrator between the id and the superego. Problems with the superego and the id cause
things like anxiety and depression, etc.
o Anna Freud Daughter of Sigmund. Worked with kids that came in from concentration camps.
Did not use analytic methods that Freud used, because she did not believe children could be
psychoanalyzed.
o Melanie Klein Contemporary of Anna, worked with object-relation idea. Developed different
kinds of therapies for children, such as play-therapy.

What are the risk factors for the development of mental illness?
o Uninterested parents, poor school environment, unsafe neighborhoods, low self-esteem, low
IQ, environment with other people suffering from mental illness, pregnancy/birth complications
 can leave people predisposed. Baby having a high fever could cause schizophrenia. Lack of
community support.

What are internalizing disorders and externalizing disorders?

o Internalizing disorders are disorders that are not easily seen, such as different forms of
depression, anxiety disorders.
o Externalizing disorders are disorders that you can see, like conduct disorder, oppositional
defiant disorder. ADD/ADHD. Schizophrenia, though rare in children.

Why would adolescence be a particularly difficult time to deal with stress and emotional upset? What would
be the special concerns of this period of life?
o Hormones are more prevalent and changing in adolescence, puberty especially. Children are
trying to figure out what they want, trying to become their own person. Body changing can be
stressful for children. Substance abuse and pressures to drink/do drugs. Metabolism is quick, so
addictions can form for children quickly. Children do not have good coping mechanisms,
impulse control center not fully functional and depression is a big problem. *Essay Question*

Chapter 2 Theories of Normality and Abnormality in Children and Adolescents

One dimensional model vs the Multidimensional model or the Biopsychosocial model of assessment
o Freudian times , your problems were thought to stem from your unconscious. Related to
experiences as a child. Behaviorism is all about reinforcements. Both of these are one
dimensional models of assessment. Multidimensional models take more into account, such as
environment and biology, physical ailment, etc.
Diathesis Stress Model Diathesis means predisposed, predisposed doesnt meant that you will
develop something youre predisposed to, but its easier for the person to develop a disorder if they
are predisposed and if person is put under a lot of stress the illness can activate.

The components of the neuron and their function:

o Cell body The central part, the nucleus.
o Axon The long extension from the cell body to the end.
o Vesicles Round transport units, transport the neurotransmitters.
o Neurotransmitters Brain chemicals.
Serotonin Mood, eating, satiation, blood clots, nausea, bone density, sexual function,
sleep, anxiety, bowel function.
Dopamine Movement, motivation, mood, controls flow of information from one part
of the brain to another.
Norepinephrine Involved in fight or flight response. Too much can cause anxiety, panic
attacks, misfiring of the sympathetic nervous system.
GABA Produced from glutamate, GABA calms you down after you have a crisis/fight or
flight response.
Glutamate Opposite of GABA, Glutamate excites. Causes action.
 o Dendrite tree like extensions on the end of the cell, this is where the neurotransmitter
receives information.
o Terminal buttons End of the axon, where neurotransmitters go into the synapse.
o Synaptic cleft Where the terminal buttons are.
o Myelin sheath Covers the axons, allows very quick transmission of neurotransmitters.

What constitutes each section of the nervous system? What are their functions?
o Central nervous system Brain and spinal cord.
o Peripheral nervous system:
Autonomic and the Somatic Autonomic, or automatic, responses that our bodies
have. Dont worry about somatic.
Sympathetic and Parasympathetic nervous systems Sympathetic produces the fight
or flight response, parasympathetic calms the body after the fight or flight.

What is the function of the Hypothalamus, Pituitary, Adrenal Axis (HPA axis)?
o This is the fight or flight response.
o Hypothalamus controls release of hormones.
Lobes of the Brain and their functions:
o Frontal Executive functions, planning, problem solving, sequential thinking, judgment,
impulse control, motor function, word articulation.
o Temporal By the ears, processes auditory stimuli. Has to do with verbal knowledge as well.
Also acts as your dictionary. Strongly connected to Broca area.
o Parietal Has to do with perception. Understanding where you are in space. Sensorimotor strip
in the front of the parietal lobe, understanding textures and temperature.
o Occipital Has to do with processing visual stimuli.

Limbic system and functions (Emotional brain):

o Amygdala Processes extreme emotions, fear and rage. Submits these to memory.
o Hippocampus Short term memory, can turn some things into long term memory, also works
as an internal GPS, knowing how to get places.
o Hypothalamus Hub of the autonomic system and the endocrine system. Called the brain of
the brain because it takes in all of the sensory information and processes it first. Triggers
pituitary gland to push out particular hormones when necessary, such as sex hormones and
growth hormones.
o Thalamus Relay station, information comes up from the body and goes through the
brainstem, the pons, and then to the thalamus, which regulates and sends it to the appropriate
part of the brain.
o Pituitary gland Repository of most of the hormones of your body. Growth hormone,
estrogen, testosterone, diuretic hormones, oxytocin, thyroid. Do not have to memorize these
particularly, just know generally that the pituitary gland is responsible for a host of these.
o Pineal gland Mostly has to do with melatonin, which regulates sleep schedule.
o Basal ganglia Doesnt initiate anything, but selects the correct groups of muscles to do
whatever you want to do, such as walking, getting up, etc.
 Brain stem structures and their functions:
o Pons Relays certain messages, sensory information, filters out some things, has to do with
facial expressions, has to do with deep sleep, has to do with regulating breathing, hearing,
balance.
o Medulla autonomic responses, heart rate, coughing, vomiting, swallowing, temperature,
reflexes.
o Reticular Formation Helps track things with your eyes, sleep, consciousness, pain modulation,
habituation.
o Cerebellum Modifies movement, helps have smooth movement, helps posture. Also has to do
with emotions.

Chapter 4 - Assessment and Therapeutic Interventions with Children and Adolescents

General areas that should be covered in a psychological interview or assessment
o Symptoms, duration of symptoms.
o Find out if theres any possibility of problems within heredity (psychopathology or physical
issues), for example depression could be caused by hypothyroidism.
o Physical cues, what theyre wearing, their habits and behaviors while talking to you. (eye
contact, disheveled clothes, etc.)
Etiology Finding out the cause of the disorder.
Course Looking at the symptom picture over a period of time. Does it change? Is it consistent?
Prognosis What does it look like at the end of life? Late in age, late 60s, 70s etc. Will the symptoms
get worse or better?
Presenting problem The problem the patient comes in with and tells you about, but you may realize
that there is a more serious problem.
Comorbidity More than one disorder is diagnosed in a person. Anxiety and depression are often
comorbid.
Clinical description Explaining what the disorder is, the symptoms, age of onset, etc.
Reliability How consistent the measure that youre using is. Will the test give the same result if the
person takes it again in two months? The MMPI-2 is very reliable, for example.
Validity How well the measure tests for what it says it will.

Strengths and limitations of:

o Structured measures:
Strength: Its very specific, its consistent. Structured.
Limitation: Not getting a lot of information that you could get in the unstructured
measure, where the patient is able to expand upon what they want to say.
o Unstructured measures:
Strength: A lot of information given.
Limitation: Client can go off on a tangent, which ends up becoming worse because you
cant get any good information from them. You have to be able to realize what
information is important and what is not.
Mental Status exam Looking at behavioral, emotional, cognitive things. Seeing how well the person is
at this exact point in time. Not making a diagnosis, just assessing right then and there. Paying attention
to dress, how they act with you (nervous, etc.), asking simple questions like their name, who the
president is.

The importance of a physical exam

o Ruling out the chance that their symptoms are not caused by some physical ailment.
What is involved in a Behavioral assessment?
o Looking for the cause of the problem behavior, looking at the consequences of the behavior.
Talk to the child about the behavior, and see what the child wants out of the situation. Giving
alternatives of behavior that would be less destructive.

Ecological Momentary Assessment (EMA) A device that beeps at a particular time of day, and when
it beeps the patient is supposed to report how theyre feeling at that particular time.

What is the purpose of the Projective measures? What do they assess for?
o They are based on the subconscious, they are meant to try and pull out the subconscious
causes of issues the child may be having.
o The Rorschach Inkblot Test Writing what the client sees in the inkblots, seeing if theres a
pattern in their answers.
o The Thematic Apperception Test Scenarios/picture of things that are ambiguous. The patient
is asked to give a story about what is going on in the picture.

Minnesota Multiphasic Personality Inventory -2 (MMPI-2) Its a personality test that assesses for
disorders by finding particular traits that are consistent with disorders. Does not necessarily mean they
HAVE the disorder, but means they have traits for it.
WISC and WAIS intelligence tests WISC is for kids 6-16, WAIS is for 16-89. Gives you an IQ score,
theres a lot of negative beliefs about it because if youre off that day you could get a score much
lower than youre actually capable of. Two subtests, performance and academic reading. Performance
is timed, and academic reading is arithmetic and word knowledge.

Brain imaging:
o CT Scan Shows structures in the brain, will not show if they are functioning properly or not.
o PET Scan Injects a radioactive substance to track how the brain is functioning.
o MRI Magnetic resonance imaging, shows more details. Shows the soft tissue, can see if
theres an obstruction or a lesion in the brain.
o ERP Event related potential. Measures memory by attaching electrodes to your scalp and
reading in the electrical pulses. Good for attention to detail.

DSM-IV vs DSM-5 DSM-IV had a lot of problems with categorical grouping of disorders. You either
had depression/schizophrenia or you didnt, there was no middle ground. The DSM-5 added a more
dimensional approach; is it severe? Moderate? How severe or not were the particular symptoms?
DSM-5 had features in it to help with sensitivity to cultural issues. Hoarding disorder, gambling
disorder was added to the DSM-5.
 Freudian approach The psychodynamic approach, the idea is to take things that are unconscious
conscious. This will cause the symptoms to abate.
o Free association saying words and having the patient say the word that comes to mind
immediately upon hearing the word.
o Catharsis - emotional vomiting, brings up a traumatic experience and allows what is
suppressed to come to the surface. Repression is a natural defense mechanism of your brain.
Cognitive Behavioral theory 3 components. Thought, feeling, behavior.
o Thought initiates feelings.
o Feeling influences behaviors.
o Analyze your thoughts, how realistic are your feelings/thoughts?
o Very effective for depressive disorders.
o Look to cognitively reconstruct your processes.
Behavioral theory, ABC Why am I behaving this way? Looking at reinforcement of behavior. Tries
to work by changing the behavior of the patient and therein helping the mental illness.

Chapter 5 Risk factors and Issues of Prevention

Risk factors for the development of mental illness in children or adolescents
o Genetic predispositions, the temperament of the child.
Temperament How they act naturally, for example a calm baby vs an anxious baby.
Psychopathology of parents How the parents mental states affect how they are able to interact with
their child, for example postpartum depression. Also, if a parent is stressed, they may be more
punishing of a child.
Parental conflict If they cannot work out their problems, splitting up is sometimes the best bet.
o Triangulating Child is pulled into the parental arguments, parents trying to get the child to
side with them.

Attachment styles:
o Secure - Parents react to the needs of their child well, and spend time with them. Children are
upset when the parents leave, and are happy to see them return. They feel safe, and will go to
the parents when they have problems. They find a great deal of comfort with their parents.
o Insecure ambivalent/resistant Mom is inconsistent in care. Not there when child needs her
all the time, not always the moms fault (work/general life stresses). Kids can grow up normal
but may be very angry.
o Insecure avoidant Child is not interested in mom coming around, they generally feel this way
because when they come to the mother they are punished/ignored. They feel they need to
deal with their issues themselves.
o Disorganized/disoriented These children are abused, very scared of their caregiver. They are
fearful when they see their parents. Could also be the mother being abused, if children see
mom being abused, they can not feel secure with her either.
Parental loss issues Heighten levels of emotional/behavioral problems. Even more of a problem if
there are problems before the death of a parent, or if there are multiple deaths. If the child is more
prepared for the loss (not a homicide, more like a long term disease, for example), this makes it easier
for the child to cope with.
Inadequate educational resources Has to do with transitions that children have a hard time with. If a
child comes from elementary school, one teacher each grade, and go to a school where they have
multiple teachers, kids may have issues. The social transition is also very tough. Kids may not feel safe
at school.
Child abuse - characteristics
o Physical Straightforward hitting, etc.
o Emotional Minimizing accomplishments, making fun of them, belittling.
o Sexual:
Traumagenic dynamic model Exposure to age-inappropriate sexual behavior.
What factors increase the damage of sexual abuse?
If its a biological father/mother, its worse than something like a stepfather.
The degree of sexual contact, the frequency/duration of it.
Lack of support after the abuse.
Use of coercion, threats.

o Neglect
Physical - Not providing clothing, shelter, food.
Emotional or psychological - Lack of love, lack of support.
Educational Not addressing childs schooling needs, for example if the child needs
glasses to see the board and the child is not provided with them. Not caring if the child
attends school at all.
o Cycle of abuse:
Tensions build.
Incident, act of abuse.
Reconciliation.
Calm period.
Start over.
o Identification with the aggressor
A lot of times, boys in particular, will identify with the abuser and will become like the
abuser. This helps the kid cope and not feel threatened.

Identify the limbic system and parts of the neuron: