Final Study Guide PDF

Lecture 15: Sleep Problems ​ able to differentiate between infant sleep and adult sleep. ○​ Newborns (up to 2 months): ​ Average: 13-14.5 hours throughout day and night ○​ Infants (2-12 months): ​ 6-month-olds can sleep through...

Lecture 15: Sleep Problems ​ able to differentiate between infant sleep and adult sleep. ○​ Newborns (up to 2 months): ​ Average: 13-14.5 hours throughout day and night ○​ Infants (2-12 months): ​ 6-month-olds can sleep through the night ​ Signalers versus self-soothers ​ Prevent sleep problems by putting down “drowsy but awake” (sleep associations) ○​ Toddlers ​ 11-13 hours a day with one nap ​ Challenges transitioning from a crib to a bed ​ Know the 2 major sleep issues in infants and young children. ○​ Difficulties initiating sleep (in children without caregiver intervention) ○​ Difficulties maintaining sleep characterized by frequent awakening or problems returning to sleep (in children difficulties to return to sleep without caregiver intervention) ​ Know the treatments and effectiveness for sleep problems in infancy (prevention/early intervention, types of extinction). ○​ 1 session teaching parents to put infant down “drowsy but awake” ​ Helps infant learn and practice skill of falling asleep on own ○​ In research: ​ Infants sleep an hour longer each night compared to control group ​ Fewer divorces in treatment group (not a significant finding due to low number of divorces) ○​ Extinction Based Interventions ​ Unmodified Extinction “Cry it Out” - 5-7 days and crying averages 45 minutes ​ Better with infants and very young children and when parents can consistently follow through ​ Child is placed in bed and any interfering behaviors (e.g., crying) are ignored until morning ​ Discontinued only if child ill, in danger, or becoming destructive ​ Extinction with Parental Presence (Camping Out) ​ Unmodified extinction with parent physically in room and ignoring crying ​ Graduated Extinction (Ferber) “Sleep Training” ​ Extinction with scheduled checks (predetermined times) that are then faded ○​ What do we know about extinction and attachment? ​ Sleep treatment works to extinguish maladaptive sleep-onset association so infants can put themselves back to sleep ​ Attachment-infant night cry may be signaling distress ​ Highly and Dozier (2009) looked at mother-infant nighttime interactions and attachment in 52 infants ​ Video observations of bedtime and night-wakings and strange situation in lab ​ Non-signalers (‘good sleepers’): equal likelihood of insecure vs. secure ​ Infants who signal: higher rates of secure attachment related to sensitive and responsive interactions at nighttime ​ Infants with secure attachment: mothers inconsistent in responding Lecture 17: 1-2 years ​ able to recognize typical language development between 12 and 24 months. ○​ More gradual progression ○​ Expressive language ​ 12-15 months ​ Using 2 words other than mama and dada ​ Naming objects and body parts ​ Copying sounds - animal sounds are big  ​ By 18 months they have about 15 words ​ By 24 months they have about 200-300 words ​ 18-24 months they combine 2-3 words ​ By 24 months use me or mine ○​ Receptive language ​ Look around when asked where's… ​ Follows one-step command ​ Can point to a picture or to one part of the body when asked ​ Know the different types of memory and the importance of procedural memory at this age. ○​ Sensory memory (< 1 sec) ○​ Short term memory (< 1 min) ○​ Long term memory (life-time) ​ Explicit memory (conscious) ​ Declarative memory (facts, events) ○​ Episodic memory (events, experiences) ○​ Semantic memory (facts, concepts) ​ Implicit memory (unconscious) ​ Procedural memory (skills, tasks) ○​ Very important because learning at this age is primarily procedural with many repetitions with variables, monitoring outcomes with a need for replication ​ Leads to implicit memory ​ familiar with Mahler’s theory of separation-individuation. ○​ Describes the psychological process by which infants transition from a symbiotic relationship with their mother to a more independent state ○​ Initial symbiotic phase ​ Hatching around 5-6 months when infant is suddenly much more interested in the world outside the dyad ○​ 9-16 months practicing: ​ Begins as the infant becomes mobile ​ Child explores out from mother ​ Less concerned that mother is watching/present ​ May be because sense of being separate from mother is still not consistent ○​ 15-24 months rapprochement crisis ​ Toddler becomes more tentative at times exploration ​ Seems worried about losing mother ​ At the same time is very driven to explore and individuate ​ Think about this for yourself - leaving home for the first time for overnight or summer camp ○​ Crisis gradually resolves with the development of object constancy ​ Different from object permanence - refers to people, to the concept that the other person has become an internal representation Lecture 18: Emotional Development in Infants and Toddlers ​ Know about the dyadic interaction patterns identified by Beatrice Beebe’s microanalysis of parent-child interaction and how these patterns relate to attachment outcomes. ○​ Beatrice Beebe studied face-to-face interaction patterns in parent-infant dyads at a micro-level using video footage ○​ In these interactions, she focused on observing how infants and parents communicate through attention, emotion/affect, spatial orientation and touch ○​ Interaction patterns identified ​ Facial and vocal mirroring ​ Parent and infant affect match each other ​ State transforming  ​ Experience of transforming an arousal state through the contribution of the partner ​ Disruption and repair ​ Experience of emotional mismatch followed by a quick repair and rematch ​ “Chase and dodge” ​ Experience of ‘derailment’ instead of repair following a mismatch ○​ Misregulation and derailment of spatial-orientation patterns without repair ○​ 4 month parent infant interaction patterns showed associations with 12 month attachment patterns ​ Ruptures that are quickly followed by rematch (within 2 sec) are predictive of secure attachment ​ Higher rate of “chase and dodge” predicted insecure attachment ○​ Beebe developed a clinical intervention that used this video feedback to improve the parent infant relationship ​ Dyad is taped, and then parent returns a few weeks later for a 2 hour feedback session ○​ The intervention is focused on the following qs ​ How do patterns of behavior of each individual affect those of the partner? ​ Can the parent verbally describe any of the ways in which he/she affects the infant, and the ways in which the infant affects him/her? ​ Are there ways in which the parent’s representation of the infant, and the parent’s own childhood history, may interfere with the ability to perceive the action-dialogue and to put it into words ​ Know the typical order of emotion expression developmental milestones. ○​ Birth ​ Distress (also contentment, interest) ○​ 2 months ​ Positive emotions (e.g., smiles) ○​ 3-4 months ​ Laughing ​ Can discriminate between happy and surprised or angry expressions ​ Infants can discriminate between mild and intense expressions of the same emotion ○​ 5-6 months ​ Primary emotions (joy, surprise, disgust, anger, sadness, fear) ​ Reliably detect changes in emotional tone in voice (happy to sad, sad to happy, etc.) ○​ End of first year ​ Use others’ emotional responses to guide their behavior ​ familiar with the early emotion regulation strategies observed during infancy. ○​ Development of emotion regulation ​ Emotional regulation: behaviors, skills, and strategies that modulate the experience and expressions of emotions ​ Emotion regulation is a key developmental task ​ Early childhood mental health referrals often relate to emotion dysregulation ​ Emotional development is strongly influenced by the caregiving environment and involves a gradual shift from other-regulation to self-regulation ○​ Early emotion regulation strategies ​ Crying ​ Averting gaze or turning body/head ​ Self-soothing (e.g., thumb-sucking) ○​ Attunement ​ Caregiver is aware of and responsive to infant affect ​ In positive relationships, this occurs somewhere from 20-30% of the time ○​ Mutual regulation ​ Interactive rhythm of connection and disconnection that is communicated over time in the parent-child relationship ○​ Rupture ○​ Repair  ​ Return to matching states after a rupture within the dyad ​ Know what social referencing is and when it appears during development. ○​ Social referencing: Looking to others’ emotional reactions to inform your reaction to a situation ○​ By end of first year, infants use others’ emotional responses to guide their behavior Lecture 19: Toddler Development (2-3 years) ​ Know how emotion recognition develops in infants and toddlers. ○​ By age 2 ​ Begin to use feeling words and states “happy” “hungry” ○​ By age 3 ​ Identify basic emotion expressions (e.g., happy, scared) ​ Situations that elicit emotions ○​ 43% of parents surveyed by Zero to Three thought children could control emotions by age 3 ○​ Developing self control demands: cognitive, language, emotional, and behavioral aspects ○​ Infants: ​ 3 month-olds can look away if they need a break ​ Regulating arousal is a dyadic process ○​ Toddlers: ​ “On the way” to self regulation ​ Try internal resources when frustrated ​ Parents help by setting limits and providing emotional support ○​ Younger children were significantly more likely to have tantrums overall ○​ 2 and 3 year olds were twice as likely as 4 and 5 year olds to have aggressive tantrums ○​ There were no significant differences by gender or race ​ familiar with the findings of Hart and Risley’s research. ○​ Vocabulary and SES ​ Observed and recorded interactions in home over time ​ Participants ranged in SES ​ By age 3, large gap in vocabulary between income groups ​ Largest vocabulary in professional’s children, then working class, then welfare ​ Know signs of toilet training readiness. ○​ Interest in toilet training ○​ Compliant ○​ Able to communicate when need to go ○​ Stay dry for longer time (2 hours) ○​ Motor skills ​ familiar with Piaget’s preoperational stage (what are some components of the stage and what are some things children cannot do at this age) ○​ 2nd stage ○​ Marked by language development ○​ Cannot reason with concrete logic ○​ Magical thinking ​ Believing that two things unrelated are related ○​ Egocentric thinking ​ Thoughts and communications typically about themselves; hard to see others’ viewpoint ○​ Centration ​ Tendency to focus on only one aspect of problem; do not have conservation Lecture 20: Attachment & Attachment Distortions ​ Know what an “Internal Working Model” is, how it develops, and how it impacts future behavior. ○​ Internal working model ​ The views and expectations we have of ourselves and others  ○​ Attachment Theory posits that normal social and emotional development depends on the formation of attachment relationships with caregivers ○​ Early caregiver-child relationships help us create prototypes for all our future relationships by influencing our internal working models ​ familiar with the Strange Situation Procedure and how children with different attachment styles respond to separations and reunions with the parent/caregiver. ○​ Standardized laboratory assessment of attachment style ○​ Toddlers (9-12 months) are introduced to a novel playroom and go through a series of separations and reunions with their caregivers ○​ Researchers look at how toddlers behave during reunions with their caregiver to determine their attachment styles ○​ Secure ​ Response to separation ​ Show distress ​ Behavior during reunion ​ Seek proximity and comfort ​ Are effectively soothed ​ Return to exploring ​ Prevalence in normative samples = 60% ​ Caregiver is usually responsive ○​ Insecure-avoidant ​ Response to separation ​ Limited distress ​ Behavior during reunion ​ Limited comfort seeking (e.g., ignore or avoid caregiver) ​ Prevalence in normative samples = 15% ​ Caregiver is usually rejecting ○​ Insecure-resistant ​ Response to separation ​ Intense distress ​ Behavior during reunion ​ May seek comfort and resist comfort ​ Not easily soothed ​ Prevalence in normative samples = 10% ​ Caregiver is usually inconsistent ​ Show bigger stress responses ○​ Disorganized ​ Response to separation ​ Varies ​ Behavior during reunion ​ Lack of an organized strategy ​ Odd or contradictory strategies ​ Prevalence in normative samples = 15% ​ Caregiver is usually atypical (e.g., frightened or frightening) ​ familiar with research findings on developmental outcomes associated with different attachment styles, and particularly how the different attachment styles relate to mental health outcomes. ○​ Attachment styles are moderately stable across early childhood ○​ Secure attachment is associated with optimal social, emotional, and behavioral outcomes ​ Recent meta-analysis also shows that attachment security is associated with better cognitive and language outcomes ○​ Insecure attachment is associated with ​ An increased risk of internalizing symptoms (e.g., anxiety, depression) ​ Particularly infants with avoidant attachment ​ An increased risk of externalizing symptoms ​ Particularly infants with disorganized attachment ​ Increased risk of social difficulties  ○​ Disorganized attachment is associated with the most negative mental health outcomes ​ Know the types of caregiver behavior patterns that are associated with infant attachment styles in the Strange Situation Procedure. ○​ Adult attachment style: secure ​ Infant attachment style: secure ​ Defining adult attachment behaviors: trust others, seek out partner when distressed, respond adaptively to relationship threats ○​ Adult attachment style: preoccupied ​ Infant attachment style: resistant ​ Defining adult attachment behaviors: fear abandonment, cling to parter ○​ Adult attachment style: dismissive ​ Infant attachment style: avoidant ​ Defining adult attachment behaviors: difficulty trusting others, may avoid intimacy or decrease dependence on others ​ Know the similarities and differences between Reactive Attachment Disorder and Disinhibited Social Engagement Disorder. ○​ Underlying cause: ​ Both disorders are associated with extremely insufficient care ​ Like neglect, deprivation, or a lack of stable caregivers ​ This neglect disrupts the formation of healthy attachment patterns ○​ Age of onset: ​ Symptoms for both disorders must manifest prior to the age of 5 years, and the child must have a developmental age of at least nine months ○​ Environmental risk tractors: ​ Deprivation or neglect of basic emotional needs ​ Stimulation, comfort, and affection ​ Frequent changes in caregivers, leading to a destabilized environment ​ Living in unusual settings, such as orphanages, that limit the ability to form selective attachments ○​ Long term impacts ​ Both disorders can lead to difficulties in forming healthy relationships later in life due to disrupted early attachment processes Lecture 21: Diagnosis of Mental Health Concerns in Young Children ​ able to recognize the typical components of a clinical early childhood mental health evaluation. ○​ What's going on now? What are the problems? ○​ Is there functional impairment? ○​ Standardized questionnaires ○​ What is the past history of mental health issues and any prior treatment? ○​ Additional information that is crucial – medical history, social history, family history ○​ Mental status exam – the most objective part of the evaluation ○​ +/- observation in another environment like school ○​ +/- bloodwork or other testing to rule out other problems ○​ Evaluation more dependent on the reports of others combined with observation ○​ Child’s limited ability to express themselves verbally ​ Know the purpose of diagnosis for young children ○​ Sometimes helps parents and teachers understand better what is going on with the child ○​ Makes research feasible because researchers are using a common set of criteria to describe a syndrome ○​ Guides clinicians to be able to recognize patterns in presentations ○​ But most importantly HELPS GUIDE PLANS FOR TREATMENT ​ able to identify the best classification system for young children and their families ○​ DC:0-5 ○​ 5 axis system ​ Axis I: clinical disorders  ​ Axis II: relational context ​ Axis III: physical health conditions and considerations ​ Avis IV: psychosocial stressors ​ Axis V: developmental competence ​ Appendix A: developmental milestones and competency ratings Lecture 22: Early Identification of Autism and Developmental Disorders ​ able to recognize symptoms of ASD ○​ Deficits in social communication ​ Social emotional reciprocity (reduced sharing interest or taking turns) ​ Nonverbal communicative behaviors in conversations (abnormalities in eye contact, gestures) ​ Developing, maintaining and understanding relationships (interest in peers) ○​ Repetitive behaviors and restricted interests ​ Stereotyped or repetitive motor movements, use of objects or speech (lining up toys) ​ Insisting on sameness (distress when change in routine) ​ Restricted, fixated interests ​ Hyper or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment (indifference to temperature, pain) ○​ Present in early developmental period ○​ Cause impairment in functioning ​ Know signs of autism at age 1. ○​ Lower levels of social interaction and communication ​ Fewer occurrences of social smiling and social interest ​ Less frequent expressions of positive affect ​ Lack of warm, joyful expressions with gaze ​ Atypical eye contact ​ Less likely to engage in the pointing behavior of joint attention ​ Less responding to name ​ Less time looking at faces ○​ Language ​ Less frequent use of complex babbling and words ​ Less frequent socially directed vocalizations ​ May have unusual prosody ○​ Motor development and sensory processing ○​ Restrictive and repetitive behaviors ​ Know the importance of screening for autism and how screening should be done. ○​ American Academy of Pediatrics recommends screening at 18 and 24 months ○​ Early identification critical for early intervention ○​ General developmental screeners (denver II, ages and stages) ○​ Specific screeners (modified checklist for autism in toddlers) ​ able to identify early intervention programs that are promising for children with autism. ○​ Early Start Denver Model (12-48 months) ​ 20 hours of therapy a week (therapists and parents) ​ ABA approach with relational focused model ​ Delivered through play ​ ‘Joint activity routine’ ○​ Early intervention services ​ Children birth to 3 with diagnosed physical or mental condition or are suspected of having a developmental disability or delay ​ Anyone can refer (social worker, caregiver, doctor) ​ Assessed after referral for services ​ If eligible individual family service plan developed; if ineligible, can request monitoring Lecture 23: Early Eating Problems and Disorders  ​ Know what types of data are used to identify growth problems in young children. ○​ Caregiver reported feeding concerns ​ Shows little interest in feeding or cries during feedings ​ Refuses to drink from a bottle / cup ​ Refuses solid foods (may still eat puréed foods) ​ Consistently refuses certain foods or whole food groups ​ Inconsistently refuses foods ​ Sleeps through feedings ​ Gags or vomits before, during, or after feedings ​ Not eating enough to gain weight ​ Know the caregiver and child risk factors associated with increased risk for feeding and eating problems. ○​ Caregiver ​ Lifetime history of earring disorder ​ Depression or anxiety ​ Parent behavior like controlling, indulgent, under-involved, non-contingent feedings ​ Low parental education, income, and younger age ○​ Child ​ Premature birth ​ Small for gestational age at birth ​ Congenital malformations ​ Infant temperament ​ familiar with the strategies used to treat selective food refusal and sensory food aversions. ○​ If child gags or vomits, don’t keep offering that food for a while ○​ If child grimaces or spits out, stop for today, but try again another day paired with a food child likes ○​ Don’t negotiate or remove privileges – then it becomes a control issue ○​ Parents model trying new foods ​ Know what parent feeding behaviors are adaptive and maladaptive. ○​ Maladaptive ​ Open restriction of food ​ Restricting own intake or child’s intake ​ Children then crave these foods in absence of hunger, gain weight later on because of eating when not hungry ​ Pressuring children to eat ​ Children end up eating in absence of hunger, do not develop link between hunger and eating ○​ Adaptive ​ Modeling intuitive and competent eating ​ Eating in response to own hunger cues, not emotional distress ​ Consistent and structured mealtimes ​ Accepting a variety of foods ​ Increased monitoring of child food intake ​ Sharing feeding responsibility with the child ​ Caregiver responsibilities: determining how, when, where, and what to feed their children ​ child responsibilities: deciding how much to eat Lecture 24: Exposure to Adverse Events and Early Childhood Trauma ​ Know which interventions have a theoretical basis in attachment theory.​ ○​ Child parent psychotherapy ○​ Circle of security ​ Know how children may express PTSD symptoms differently than adults. ○​ Child may not explicitly report trauma ○​ Intrusion symptoms may look different and not obviously distress the child ​ Distress is not always apparent with recurrent recollections of the trauma  ​ May demonstrate their experience of trauma through play, drawings, and stories ​ May ask repeated questions about the event, sometimes without distress ​ Frightening dreams and other fears may not reveal actual trauma content ○​ Physiological reactions without other symptoms when reminded of trauma ○​ Alterations in reactivity may include extreme temper tantrums ○​ Instead of flashbacks, may see dissociation in form of freezing or staring ○​ May see associated regressive behaviors ​ Know the adverse events measured in the ACE study and general findings of the study. ○​ Abuse ​ Emotional abuse ​ Physical abuse ​ Sexual abuse ○​ Household challenges ​ Mother treated violently ​ Households substance abuse ​ Household mental illness ​ Parental separation or divorce ​ Incarcerated household member ○​ Neglect ​ Emotional neglect ​ Physical neglect ○​ As the number of ACEs increases so does the risk for the following ​ Depression ​ Suicide attempts ​ Alcoholism, alcohol abuse, illicit drug use ​ Chronic obstructive pulmonary disease ​ Ischemic heart disease ​ Diabetes ​ Cancer ​ Smoking ​ Multiple sexual partners ​ Sexually transmitted disease ​ Unintended pregnancies ​ Poor work performance ​ Financial stress ​ Risk for intimate partner violence ​ Poor academic achievement attachment disturbances ​ familiar with treatment techniques used in Child Parent Psychotherapy and who the treatment is designed to treat. ○​ Attachment based intervention for children 0-5 who are at risk for mental health problems due to exposure to trauma or other adversity ○​ Has been studied with immigrant families, mothers with exposure to violence, mothers with depression, children in child welfare system or who witnessed domestic violence ○​ Research on child parent psychotherapy has suggested ​ Reduced child and maternal psychiatric symptoms ​ Improved positive child attributions ​ Improved child-mother relationship ​ Improved attachment security ​ Improved cognitive functioning of the child ○​ Goals of child-parent psychotherapy are to: ​ Enhance parent’s capacity to respond in developmentally appropriate ways to child’s basic needs ​ Restore trust in parent’s ability to protect child from internal and external danger ○​ Clinician observes child-parent interactions during play, physical interactions during play, physical contact, or verbal exchanges, and explores the parent’s attributions for the child’s behavior ○​ Clinician may also:  ​ Enhance parent insight into their responses to their child ​ Provide guidance on developmentally appropriate child behavior ​ Model protective behavior for parent Lecture 25: Identifying and Treating Early Childhood Internalizing Behavior ​ able to identify components of effective treatment for early childhood anxiety. ○​ Behavioral treatments key components ​ Psychoeducation ​ High parent involvement ​ Graduated exposure ​ Reinforced practice ​ Differential attention (positive attention to brave behavior) ​ familiar with characteristics of behavioral inhibition and outcomes of young children with behavioral inhibition. ○​ Unusually shy and fearful as toddler ○​ Quiet and withdrawn in unfamiliar settings ○​ Observable signs of behavioral inhibition: ​ Long latencies before interacting with unfamiliar adults ​ Cessation of play or vocalization ​ Clinging to mother ​ Fretting or crying ○​ Research examining behavioral inhibition over time has found evidence for long-term stability and correlations with anxiety ○​ Children who showed stable (consistent) behavioral inhibition were: ​ More likely to meet criteria for an anxiety disorder ​ More likely to have multiple anxiety disorders ​ More likely to have parents with childhood and adulthood anxiety disorders ​ More likely to show greater physiological arousal in unfamiliar situations ​ Know barriers to diagnosing anxiety in young children. ○​ Compared to older individuals, young children are rarely referred for treatment ​ Children often lack cognitive abilities to talk about fear, worry, and panic ​ Assessment relies on caregiver report ○​ Controversy over using diagnostic constructs with young children, which has not always been sensitive toward them (e.g., separation anxiety and sleep) ○​ Research has focused more on child development and temperament than on clinical levels of anxiety ○​ However, early onset leads to greater chronicity and impairment ​ Including increased likelihood to develop other disorders later ​ familiar with Selective Mutism (rates, characteristics, and treatment). ○​ Absence of speech in specific public situations in which the child is expecting to speak, while in other situations the child’s production of speech is apparently quite normal ○​ Does not exclusively occur during first month of school ○​ Age of onset 2-5 years ○​ 2:1 female to male ratio ○​ Rare