Psikologi Anak
Pertemuan 12
Health Related problems and substance use
Sleep Disorders
The Regulatory Functions of Sleep
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sleep is the main activity of the brain in the first years of life
sleep is essential for brain development and regulation
sleep deprivation impairs functioning of the prefrontal cortex, leading to
decreased concentration and diminished ability to inhibit or control basic drives,
impulses, and emotions
sleep produces an “uncoupling” of neurobehavioral systems, allowing for retuning
of CNS components
Maturational Changes
sleep patterns, needs, and problems change over the course of maturation
• infants and toddlers have more night-waking problems
• preschoolers have more falling-asleep problems
• younger school-aged children have more going-to-bed problems
• adolescents have more difficulty going to or staying asleep, or having enough time
to sleep
• adolescents have increased physiological need for sleep, however, they often get
less sleep than needed and are chronically sleep-deprived
Dyssomnias
Parasomnias
• Disorders of initiating or
maintaining sleep,
characterized by
difficulty getting enough
sleep, not sleeping when
one wants to, not feeling
refreshed from sleep
• Most of these sleep
problems resolve
themselves as the child
matures
• Quite common in
childhood, with the
exception of narcolepsy
• Disorders in which
behavioral or physiological
events intrude upon
ongoing sleep
• Common afflictions of
early to mid-childhood;
children typically grow out
of them
• Include nightmares (often
called REM parasomnias),
sleep terrors and
sleepwalking (often
referred to as arousal
parasomnias)
Treatment
• behavioral interventions and establishing good sleep
hygiene can help children with difficulty going to and
staying asleep
• behavioral interventions for circadian rhythm disorders
can be effective when adolescent and family are highly
motivated
• treatment of nightmares consists of providing comfort
at the time of occurrence and making efforts to reduce
daytime stressors
• parents of children who sleepwalk should take
precautions to avoid chances of child being injured;
brief afternoon naps may be beneficial
Elimination Disorders: Enuresis
• involuntary discharge of urine during day or night at least twice a week for
three months or accompanied by significant distress or impairment, in a
child at least 5 years old
• nocturnal enuresis most common (about 13-33% of all 5-year olds) and
affects boys more than girls
• diurnal enuresis more common in females; believed to be associated with
social anxiety or preoccupation with a school event
• more common among less educated, lower SES, and institutionalized
children
• may be primary, if never attained continence, or secondary, if control
established and then lost (less common)
• causes include deficiency of antidiuretic hormone, genetic predisposition,
and immature signaling mechanism
• most successful treatments are behavioral training methods using either
operant conditioning or classical conditioning (especially the urine alarm)
Elimination disorders: Encopresis
• the passage of feces into inappropriate places at least once per
month for 3 months in a child at least 4 years old
• 2 DSM-IV subtypes: with or without constipation and overflow
incontinence (former more common)
• occurs in 1.5%-3% of children; declines rapidly with age
• 5-6 times more common in boys
• like enuresis, categorized as primary or secondary
• psychological problems likely result from, rather than cause it
• causes include untreated constipation and abnormal defecation
dynamics
• treatment includes the use of fiber, enemas, or laxatives to treat
the constipation, followed by behavioral and biofeedback
interventions to establish healthy elimination patterns
Adolescent Substance Abuse
Disorders (SUDs)
• SUDs in adolescence include substance dependence and
substance abuse, resulting from self-administration of any
substance that alters mood, perception, or functioning
• Can lead to psychological and physiological dependence
• For a diagnosis of substance dependence, must show a
maladaptive pattern of substance use for at least 12
months, with three or more clinical signs of distress such as
tolerance or withdrawal
• Criteria for substance abuse involves one or more harmful
and repeated negative consequences of substance abuse
over the last 12 months; given if individual does not meet
criteria for dependence
Adolescent Substance Abuse
Disorders (SUDs)
Prevalence and Course
• alcohol is the most prevalent substance used and abused by
adolescents; cigarettes are second most common
• illicit substance use also common; typically marijuana is used, but
the use of other illicit drugs such as MDMA, opiates, cocaine, and
crack is increasing
• 8% of adolescents aged 12-17 met criteria for substance abuse or
dependence in 2001 survey
• rates peak around late adolescence and begin to decline during
young adulthood
• concern greatest when high-risk behaviors begin well before
adolescence, are ongoing, and occur among peer group with similar
behaviors
• high comorbidity with ADHD and conduct problems
Adolescent Substance Abuse
Disorders (SUDs)
Causes
• personality characteristics such as increased sensation
seeking- a preference for novel, complex and ambiguous
stimuli
• positive attitudes about substance abuse and having
friends with similar attitudes, perceiving oneself to be
physically older than same-age peers, and school
connectedness
• lack of parental involvement and parent-child affection,
inconsistent parenting and poor monitoring, negative
parent-child and inter-parent interactions, and low parental
expectations for abstaining
• association with deviant and substance using peers
Treatment and Prevention
• half of patients for SUDs relapse within first three months, and only 2030% remain abstinent
• Family based approaches that seek to modify negative reactions between
family members, improve communication, and develop effective problem
solving skills to deal with areas of conflict
• Multisystemic Therapy (MST) involves intensive intervention that targets
family, peer, school, and community systems
• adolescents with more severe levels of abuse and unstable living
conditions, or comorbid psychopathology require inpatient or residential
setting
• Life Skills Training emphasizes building drug resistance skills, personal and
social competence, and altering cognitive expectancies around substance
abuse
• prevention efforts target social environment via community and school
norms, and include parent involvement and education to improve parentchild communication about substance use
Feeding and Eating Disorders
Feeding Disorders
• Infant or child refuses, is unable or has
difficulty eating
– Frequent illnesses
– Failure to thrive
• Not the same as eating disorders
– Anorexia, bulimia – more common in adolescence
and adulthood
Feeding Disorders
Types of Feeding disorders:
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Adipsia - absence of thirst
Dysphagia - real or imagined difficulty swallowing
Food refusal
Inability to self-feed
Taking too long
Choking; gagging or vomiting when eating
Picky eating according to food type or texture
Prevalence and Causes:
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Approx. 25%, most common in children with developmental disorders
Medical conditions
Children tube fed through illness
Prematurity – reflux
Food allergies
Behaviour disorders
Eating Disorders
• Anorexia Nervosa – refusal to maintain a
minimally normal body weight, intense fear of
weight gain, significant disturbance in
perception of body size
• Bulimia Nervosa – binge eating and
inappropriate compensatory methods to
prevent weight gain, excessively influenced by
body shape and weight
Risk Factors
School age
Adolescence
• Primary school children want to
be thinner than they are (up to
45%)
• 37% try some form of weight
loss and 6.9% score in
pathological range on Eating
Attitudes Test
• Food refusal, ritualistic
behaviour, internalizing
symptomatology (anxious,
withdrawn, somatic complaints)
• Female gender
• Girls who feel negatively about
their bodies at puberty
• Anxious attachment
• Affective problems
• Discomfort discussing problems
with parents
• Maternal preoccupation with diet
• Family history
• Personality/temperament
• Sexual abuse
Etiology
Psychoanalytic
• Symbolic of unresolved unconscious conflict
– Difficult to test
• Poor mother-child relationship
– Rejecting mothers produce self-hate in their daughters
– Daughters hate their bodies (too fat)
– Evidence not consistent – most dislike their body shape but do not have
rejecting parents
Behavioural approach
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Food avoidance or overindulgence is reinforced
Attention, control over parents
A better explanation for maintenance than for cause
Most with An are not rebellious but obedient, conscientious and
sometimes excellent athletes, perfectionists
Etiology
Cognitive Behavioural approach
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Begin with conditioned food aversions
Pair eating with obesity
Become revolted by food
Food avoidance maintained by sense of control by restricting
Faulty attributions used to justify food avoidance (‘you can’t be too thin’)
Social Psychological Approach
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Cultural standards of beauty
Ideal thin female figure
1960’s, 1970’s increasingly thin ideal
Women who try to meet the thin ideal have no choice but to diet and
some cannot stop
– Some evidence (models, dancers, athletes)
Major Precipitants of an Eating Disorder
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Physical maturation
Entry into high school
Loss
An illness associated with weight loss
Peer teasing
Dieting
Warning Signs
To distinguish ‘normal’ dieting from an eating
disorder
• Dieting associated with decreasing weight goals
• Dieting associated with increasing criticism of
body
• Dieting associated with social isolation
• Dieting associated with purging
• Dieting associated with amenorrhea
Treatment
• Multi-disciplinary team
• Medical – adequate weight gain and return to
physical health
• Nutritional – resumption of normal eating
• Psychological – resolution of distorted cognitions,
body image problems, self esteem, comorbid
disorders
• Family – individuation, family relationships,
parent-child conflict issues