Pediatric Psychology

Published on July 2016 | Categories: Types, Research | Downloads: 43 | Comments: 0 | Views: 263
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Pediatric Psychology

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Pediatric Psychology Elimination Disorders Developmental sequence: control over nighttime bowel, daytime bowel, daytime bladder, nighttime bladder. Usually by 36 months this sequence is completed. Enuresis: loss of bladder control unexplained by a predisposing physical disorder, e.g. diabetes; diagnosed after the age of 5 when control is expected; diagnosed if there are two or more events per month; primary (85% of cases) vs. secondary; emotional problems are the result of enuresis, not the cause; possible causes: chaotic home environment; sleep abnormalities; they may produce more urine at nighttime due to the lack of an antidiuretic hormone; genetic predisposition; bladder capacity; arousal deficit; faulty training; failure to control reflexive wetting Treatment: an antidiuretic called desmopressin acetate; bedwetting resumes if medication is removed; treatment of choice: bell and pad system for a period of 5 to 12 weeks; relapse is not unusual (40%); add cleanliness training, retention control, overlearning Encopresis: loss of bowel control unexplained by predisposing physical condition; after age 4, if it occurs once a month a diagnosis is given; the majority of encopretic children are constantly constipated with overflow incontinence; 2-3% of 7 and 8 year olds, decreasing with age; rare by adolescence; no associated psychopathology; occurs more during the day, therefore a social problem; related to diet, fluid intake, meds, stressors or inappropriate training; physiological/anatomical mechanisms for bowel control are inadequate Treatment: initial cleanout phase, regular toilet times, use of suppositories, modification in diet, laxatives and stool softeners used, reward success, provide consequences by making the child clean themselves, their clothing or bedding.

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Sleep Disorders Normal: 16 hours for infant, 12 hours for one-year-old; 8 hours for ten year old; REM and NREM Sleep problems: difficulty going to sleep, excessive sleepiness, waking in the night, nightmares, night terrors, night walking; one-third of children and adolescents report problems Dyssomnias: sleep and waking problems; inability to self sooth; etiology: difficult temperaments, family discord, parenting practices; treatment of choice: regular and consistent bedtime routines, extinction by ignoring crying child; putting child in crib partially awake to promote self-soothing skills Parasomnias: sleepwalking (somnambulism), sleep terrors, nightmares Somnabulism: disappears by adolescence; may become dangerous; no hidden observer as once thought; exacerbated by stressors, fatigue, physical illness; unrelated to REM Night terrors: between 4 and 12, more boys: NREM Nightmares: REM; manifestation of real anxieties EATING PROBLEMS Rumination disorder: voluntary and repeated regurgitation of food or liquid; by age one in normal children; persistent in children with MR; more prevalent in boys; etiology founded in mother-child relationship; treatment: aversive conditioning Pica: eating inedible substances; most common in 2-3 year olds; high among MR children Feeding Disorder of Infancy/Early Childhood: failure to eat adequately; failure to gain weight; failure to thrive; etiology: child variables: difficult temperament, illness, disabilities, low birth weight; parent variables: psychopathology, lack of skills, poor attachment; social context: poverty, conflict, neglect
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Obesity: an American epidemic in childhood; related to heart disease, diabetes, social and psychological difficulties; perceived as lazy, stupid, cheats by peers as young as six; social isolation, rejection, discrimination throughout adolescence and adulthood In the news: litigation against fast food places and against Nabisco for Oreos Treatment: education and behavior modification for children and their parents in four areas: intake of food, activity, external and internal cues; rewards for progress Eating Disorders: Binge Eating, Bulimia, Anorexia Anorexia Nervosa • Defined as weight less than 85% of that expected for a person of that height and body frame • Distorted perception of the weight or shape of their body • Intense fear of obesity and relentless pursuit of thinness • Experience of amenorrhea, the absence of at least three consecutive menstrual cycles • Commonly begins in overweight adolescents • Dramatic weight loss • Two types: restricting type, and binge-eat-purge type (less food, more purge than bulimics) • BEP types: more impulsive, self-mutilating, emotionally labile • Average patient is 35-40% under normal weight when treatment begins • Good at saying what others want to hear; deceptive in behaviors • 10% die, as may as half by suicide • Proud of their diets and their success at weight loss • Often have a history of bulimia • Some take great pleasure in cooking high-calorie meals for others • Eccentric eating habits: hoarding, eating rituals, very slow eating

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Medical Consequences • • • • • • • • • • Cessation of menstruation (amenorrhea) Dry skin, brittle nails/hair Sensitivity to cold Lanugo on limbs and cheeks Yellowing of skin Cardiovascular problems Gastrointestinal distress Muscular weakness anemia Substance abuse, mood, anxiety, and OCD disorders comorbid

Bulimia Nervosa • Bingeing and purging, out of control • Purging techniques: vomiting, laxatives, diuretics, exercise, fasting • Types: purging (2/3) and nonpurging (1/3); purging types are more severe pathology, with higher prevalence of depression and panic disorder • Purging reduces calorie intake by only 50%; laxatives have little effect • Self-esteem dependent on weight loss • Ashamed of their food intake and their lack of control • No inaccurate perception of body as in anorexia • Weight remains average or above average Medical Consequences • • • • • • Salivary gland enlargement, chubby face Erosion of dental enamel Electrolyte imbalance resulting in arrhythmia and kidney failure Severe constipation and permanent colon damage Calluses on fingers and hands due to sticking fingers down throat Anxiety and mood disorder, substance abuse comorbid
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Binge-Eating Disorder (BED) • Marked distress due to bingeing, but with no compensatory behaviors • Often found in weight reduction programs, i.e. Overeaters Anonymous • Less gender related than other two • More psychosexual dysfunction in BEDs • Men: anxiety and substance abuse • Women: anxiety, anger, frustration, depression

STATISTICS • Mostly women, with 10% males who are homo/bi/asexual, or athletes • Age of onset: 16 to 19 • 6 to 8% of college females meet criteria for Bulimia • One in five women of these women will still struggle with the problems ten years later • Heatherton longitudinal research: eating-disordered behavior among 509 women and 206 men declined substantially over a ten year period, with rates dropping by more than half • Major risk factors: overweight, higher SES, acculturation to norms • Increase in minority incidences and cross culturally when influenced by Western standards • Possible for eating disorders to begin after the age of 55 CAUSES • Sociocultural Dimensions: body consciousness, percentage of body fat both related to personal happiness and success in the minds of these young women; the glorification of slimness in media. Positive correlation between watching TV and body dissatisfaction among
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girls; 60% of adolescent girls are dieting, compared to 30% of boys; male and females ratings of bodies found that girls perceived the ideal body weight less than the weight boys thought most attractive • Family dimensions: successful, hard-driving, concerned about external appearances, eager to maintain harmony, often deny conflict, little communication among themselves; chaotic, incapable of resolving conflict, unaffectionate, unempathic to the needs of the child; lacking a close-knit style of relating mothers want their daughters to be thin, and are more likely dieting themselves; overly involved; perfectionistic • Biological dimensions: genetics may account for half the variation in susceptibility to eating disorders; low levels of serotonin associate with low impulse control and binge eating; SSRIs used to treat • Psychological dimensions: diminished sense of personal control, lack of confidence in their abilities and talents; preoccupied with appearances; feeling like imposters in their social groups; difficulty understanding and labeling emotions; eating as a response to inner pain; related to history of being physically or sexually abused; history of avoiding rather than resolving problems; unresolved dependency on parents; related to later diagnosis of borderline personality disorder; distortion in perception of body shape; bulimics judge their bodies to change after eating a candy bar; increased anxiety before and during snacking is relieved by purging; therefore, purging is positively reinforced and increased in frequency. TREATMENT • Drugs: antidepressants, such as Prozac, are more effective than a placebo in controlling relapses, maintaining weight gains and reducing other symptoms • Cognitive-behavioral treatment and Interpersonal Therapy (focusing on interpersonal relationships rather than the eating problems) proved more successful than behavioral therapy alone • Group therapy can often be helpful when members of the group provide help and support to each other
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IMPULSE-CONTROL DISORDERS • Kleptomania: a persistent urge to steal, with no motive to own the objects stolen; related to temporary thrill and release of tension that feels gratifying, followed often by guilt and remorse; acquired items are often thrown away, given away or hoarded; because kleptomania is seen as an obsessive-compulsive disorder, the SSRIs are used to treat • Pathological Gambling: related to male, non-White, unmarried, alcohol dependent, nicotine dependent, antisocial personality disorder • Pyromania: a compulsive and dangerous urge to set fires deliberately; fascination and curiosity related to fires; often have police scanners to alert them to ongoing fires; most common in males; onset in childhood or adolescence; low levels of education and employment • Sexual impulsivity: inability to control the number of sexual encounters or even the contexts in which sexual encounters occur; also known as sexual addiction, sexual dependency and sexual compulsivity; Quadland research, 1085: subjects reported more than 29 partners per month and more than 2.000 sexual encounters over their lifetimes; more men than women • Trichotillomania: the urge to pull out one’s hair; hair-pulling brings relief from tension, pleasure or gratification; some patients swallow the hair which may cause a condition called trichobezoar, or Rapunzel syndrome; may have a desire to pull the hair of other people, of pets, dolls or clothing; comorbid with OCD, substance abuse, eating disorder, depression • Intermittent Explosive Disorder: a recurrent inability to resist assaultive or destructive acts of aggression; described as a seizure state preceded by a tingling, tremor, heart palpitations, head pressure or auditory echoes; more men than women

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