Atypical Child and Adolescent Development Spring 2009 Chapter 12 Health-Related and Substance Use Disorders History As a result of acute infectious diseases such as smallpox, typhus etc., the emotional connection between parent and child was often greatly diminished. Sleep Primary activity of the brain during early childhood. During the first 2 years of life the brain reaches 90% of adult size. Much of this growth occurs while asleep. Approximately 5-years-old ? child reaches a more balanced wake-sleep state. Problems with sleep and psychological problems are bidirectional in nature. Sleep Prefrontal cortex ? integrates cognitions, with emotions, and social information. Lack of appropriate amounts of sleep can result in a reduced ability to think clearly and regulate emotions. Sleep During sleep there is a disconnect with the central nervous system (CNS) to allow recalibration of neural connections. Maturational Changes Newborns ? sleep 16 to 17 hours each day. Infants and toddlers have more night-waking problems. Preschoolers ? have difficulty with falling-asleep. Younger school aged children exhibit more going-to-bed problems. Adolescents and adults - usually have more difficulty with going to or staying asleep (insomnia). Adolescents have a greater need for sleep. Appropriate Sleep Newborn up to 18 hours 1?12 months 14?18 hours 1?3 years 12?15 hours 3?5 years 11?13 hours 5?12 years 9?11 hours Adolescents 9?10 hours Adults, including elderly 7?8 (+) hours Pregnant women 8 (+) hours Sleep Disorders Dyssomnias ? disturbance in amount, timing, or quality of sleep (e.g. problems with getting to sleep). Protodyssomina ? difficulty initiating sleep. Hypersomnia ? excessive sleepiness Narcolepsy ? daytime sleepiness, sleep attacks with loss of muscle tone. Breathing-related sleep disorder- e.g. Sleep apnea Circadian rhythm sleep disorder Parasomnias Parasomnias ? common during early to mid-childhood Nightmares ? Rapid Eye Movement (REM) sleep. Vivid recollection of disturbing dreams Parasomnias Sleep Terror ? Recurrent abrupt awakening from sleep with extreme autonomic arousal. Sleepwalking ? arising from bed ? 5 sec. to 30 min. no memory in the morning. Treatment Good Sleep Hygiene ? establishing a positive routine (e.g. singing, playing a quiet game, reading ? not on the bed). Treatment for Parasomnia is usually not necessary as it usually abates on its own. Sleepwalking may be the result of excessive fatigue or stresses during the day. Brief naps may alleviate the problems. Elimination Disorders Historically enuresis and encopresis was thought to be solely due to stubbornness of the child (belief that children should be potty-trained by 8 months old). Severe means were employed to correct this disorder (e.g. sacral plasters, chloral hydrate to stimulate the bladder, orifice of the urethra was cauterized with silver nitrate to make it more responsive to passage of urine. Enuresis Prevalance ? 13 ? 33% of 5-year-olds. More common in boys Declines dramatically by age 10 -3% males 2% females. 1% males in adolescence, less than 1% females in adolescence. Higher among lower SES groups, institutionalized children. Etiology Primary enuresis ? 85% lack of consistent nighttime control. By age 5 most problems with enuresis abates. Small percentage that continue to have problems may be due to a deficiency in the antidiuretic hormone (ADH) which helps the child to concentrate urine during sleep hrs. Child may not have developed the ability to sense a full bladder at night. Enuresis Primary enuresis is inherited. Both parents ?77% of children will have enuresis. One parent ?44% of children will have enuresis Monozygotic twins ? 68%, Dysgenic twins ? 36% Secondary enuresis Encopresis Passage of feces into inappropriate places, (e.g. clothing, floor) Occurs once per month for 3 months. Prevalence ? 1.5% to 3% more common in boys. Megacolon ? enlarged colon due to not releasing feces. Stretched muscles and nerves give fewer signals to child to eliminate feces. With or without constipation Treatment Urine alarms Bladder retention control training Dry bed training reinforcements for a dry bed Chronic Illness Chronic illness ? lasting 3 months continuous hospitalization more than 1mo. Somatoform disorders ? related symptoms that suggest a medical condition but lacks the organic or physiological evidence. Chronic Illness Somatization ? the expression of feelings through physical symptoms such as pain and gastrointestinal complaints. Hypochondriasis ? preoccupation with real or imagined illnesses. Child Adaptation to Chronic Disease Biopsychosocial model ? model that attempts to explain behavior by taking into account psychological, social, and biological factors. Child Adaptation to Chronic Disease Transactual stress and coping model - illustrates how children cope with the effects of a chronic disease. E.g. psychological factors, parental adjustment, and illness factors. Adolescent Substance Use Disorders Abuse is gauged by how much of the substance interferes with the individual?s life. (E.g. relationships, work, school, or dangerous situations) Adolescent Substance Use Disorders Psychological dependence ? the feeling that the individual needs a substance to function normally. Physical dependence ? body adapts to the constant presence of substance. Tolerance ? the necessity of acquiring more of a substance to achieve the same effect that was previously acquired at a lower dose. Withdrawal ? physiological symptoms as a result of an abrupt end to substance. Substance Withdrawal Anxiety Depression Psychosis Three fourths of those in substance abuse clinics have additional psychiatric disorder. Schizophrenia and anti social personality disorder likely to have substance abuse as well. Substance Abuse Prevalence ? 4 in 5 high school seniors, 2 in 3 10th graders reported alcohol use. Onset ? alcohol use before age 14 a strong predictor for dependence. Girls typically use fewer types of drugs and less often then boys. Girls who report dating aggression are 5 times more likely to use then girls who date non-aggressive boys. Alcohol effects Etiology for Abuse Risk factors Sensation seeking Peer involvement Family functioning Family history Perceiving self as older with same aged or striving for adult roles. Low parental monitoring Treatment One half of adolescents receiving treatment for substance abuse relapse within first 3 months. 20 ? 30% remain abstinent for 1 year. Multisystemic model Problem solving skills education Improve communication between family members. Peer relationships School
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